Under the direction of the Deputy Division Chief, with wide latitude for independent initiative and judgment, the Claims Integrity & Compliance Officer (“CIIO” or “Officer”) is responsible for the development, implementation, and oversight of a comprehensive claims integrity and compliance program.
This role encompasses operational oversight, regulatory compliance, and fraud detection and prevention. The Officer will analyze broad claims data to identify trends and anomalies, conduct targeted investigations into suspected fraudulent activity, and design proactive strategies to mitigate risk and ensure program integrity.
The Claims Integrity & Compliance Officer will develop and deliver internal and external fraud prevention trainings and conduct or coordinate investigations to identify, detect, and prevent violations of applicable laws, rules, and regulations. In this capacity, the Officer will serve as the Division’s primary liaison to the New York City Department of Investigation and other oversight entities, ensuring coordination on matters related to fraud and compliance.
Additional responsibilities include, but are not limited to, managing surveillance and investigative resources to validate entitlement to workers’ compensation benefits, identifying opportunities to improve operational efficiency and strengthen regulatory compliance, establishing and maintaining reporting mechanisms for employees and external parties to report suspected fraud, as well as the executing special projects and initiatives related to claims integrity, as assigned.
ADMINISTRATIVE INVESTIGATOR (N - 1002I