This class is responsible for managing a Department’s insurance fraud investigative operations.
Nature and Scope
An employee in this class reports to an administrative superior and is responsible for directing an insurance fraud investigative operation through subordinate supervisors. Work involves planning, directing, evaluating, implementing, and coordinating insurance fraud investigative and preventative operations. Develops and implements operational policies and procedures to ensure efficient and consistent application of insurance fraud investigations. Provides long and short range plans; serves on national committees; develops educational programs and prepares legislation to ensure direction of the Insurance Fraud Investigation Unit remains consistent with national efforts.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Directs the overall operation of the Insurance Fraud Investigation Unit; plans, implements and evaluates insurance fraud investigations.
Develops, implements and evaluates insurance fraud investigation policies and procedures.
Develops and recommends strategic plans for unit operations; assesses, analyzes and determines both long and short range goals for the unit.
Represents the Department on various committees and task forces at the state and national level in all insurance fraud related matters.
Prepares legislation to ensure direction of Insurance Fraud Unit operations remain consistent with national efforts.
Develops and implements policies and procedures consistent with legislative changes in insurance fraud laws and initiatives.
Develops and conducts insurance fraud training programs for statewide law enforcement classes.
Develops and conducts educational programs on public awareness of insurance fraud investigations at the state and national level.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of department goals and objectives.
Knowledge of management practices and procedures.
Knowledge of insurance industry laws, rules and regulations.
Knowledge of investigative procedures as it applies to criminal and civil law.
Knowledge of criminal and civil court requirements and procedures for case preparation.
Skill in planning, directing, implementing and evaluating insurance fraud investigations.
Skill in technical and investigative report writing.
Skill in staff supervision which includes planning, assigning, reviewing, evaluating, coaching, training, recommending employment and performance related actions.
Skill in interpreting and communicating insurance industry laws, rules and regulations.
Skill in assessing the merit of complex insurance fraud investigations.
Skill in developing, implementing and evaluating policies and procedures.
Ability to draft legislation and narrative reports.
JOB REQUIREMENTS for Administrator, Insurance Fraud Bureau Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Three years experience in planning, directing, implementing and evaluating insurance fraud investigations.
Six months experience in program administration such as overseeing and directing the development, implementation and evaluation of programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
Three years experience in interpreting insurance industry laws, rules, regulations, standards, policies and procedures.
Three years experience in providing testimony before boards, commissions, administrative bodies or court officials.
Six months experience in developing policies or procedures.
Six months experience in strategic planning such as planning and mapping a path between the present and future usually for three to five years by determining key objectives, how to accomplish the key objectives, what strategies should be used, what activities would contribute to accomplishing the key objectives and developing performance measures to gauge and report progress or success.
Six months experience in staff supervision which includes planning, assigning, reviewing, and evaluating the work of others.