Chief Compliance/Audit Investigator

State of Nevada•Las Vegas, NV

6d•Onsite

About The Position

The Department of Business and Industry is recruiting to fill a Chief Compliance/Audit Investigator position within the Insurance Division in Las Vegas. The incumbent will direct investigative activities in compliance with Division, state, federal, and other applicable statutes and regulations; assign cases and audits to investigators as well as maintain their own cases and audits; review investigator cases, prepare reports, and make referrals for administrative or criminal enforcement as warranted; and travel to meet witnesses and respondents and conduct on-site investigations and audits of licensees’ offices. They will also identify needs and deploy additional training for investigators; maintain current and comprehensive policies and procedures for the section; ensure CJIS requirements are met; participate in NAIC meetings, task forces, working groups, calls, and other related activities and keep the Division updated with respect to these activities; testify as needed in hearings and court proceedings; and maintain and submit statistical information for monthly reporting. Under general direction, incumbents are responsible for the administration of investigative activities on a statewide basis. They establish and direct investigative activities based on department goals and objectives; review and evaluate operational efficiency and compliance with program policy and procedures; and directly supervise a staff of subordinate Compliance/Audit Investigators performing Medicaid, securities, real estate, mortgage lending, insurance, prevailing wage or workers’ compensation investigations and audits. Incumbents assist in the planning and development of the program budget, internal policy and procedure, and the implementation or introduction of State legislation. In addition, they work directly with the Program Administrator, agency heads, business representatives, violators, the complainant and judicial system regarding complaint resolution, regaining compliance, pursuing criminal prosecution, imposing administrative sanctions or penalties or addressing a hearings board or commission.

Requirements

Bachelor's degree from an accredited college or university in business or public administration, business management, accounting, or related field and four years of professional experience in an investigative, auditing or professional program-related position which required the application of federal and/or State laws, policy and procedure in making program compliance determinations; preparing detailed reports for the purpose of justifying administrative sanction penalties or changes in management practices, policy and procedure; or recommending criminal prosecution.
OR graduation from high school or equivalent education and six years of experience, four of which were in a professional investigative, auditing or professional program-related position which required the application of federal and/or State laws, policy and procedure in making program compliance determinations; preparing detailed reports for the purpose of justifying administrative sanctions, penalties or changes in management practices, policy and procedure; or recommending criminal prosecution.
OR two years of experience as a Compliance/Audit Investigator III in Nevada State service.
OR an equivalent combination of education and experience as described above.
Detailed knowledge of: the purpose, activities and functions of the program area as applied to administering audit/compliance activities.
Working knowledge of: rules of evidence, rights of citizens and court procedures.
Ability to: oversee audit/investigative activities on a statewide basis; supervise and evaluate the performance of a large staff; plan, organize and assign work to subordinate staff; gain the respect of others; negotiate and formulate complaint resolution; explain methods and requirements for compliance with agency policy; provide presentations to senior managers, commission and formal business meetings/groups, simplifying complex ideas and information; assist in the development of agency goals, objectives, operating policy and procedure; and testify in a court of law.

Responsibilities

Direct investigative activities in compliance with Division, state, federal, and other applicable statutes and regulations.
Assign cases and audits to investigators as well as maintain their own cases and audits.
Review investigator cases, prepare reports, and make referrals for administrative or criminal enforcement as warranted.
Travel to meet witnesses and respondents and conduct on-site investigations and audits of licensees’ offices.
Identify needs and deploy additional training for investigators.
Maintain current and comprehensive policies and procedures for the section.
Ensure CJIS requirements are met.
Participate in NAIC meetings, task forces, working groups, calls, and other related activities and keep the Division updated with respect to these activities.
Testify as needed in hearings and court proceedings.
Maintain and submit statistical information for monthly reporting.
Receive and review formal complaints; make determinations regarding possible program violations and jurisdiction within the specified program area.
Gather and analyze background information and facts pertaining to the complaint; make determinations regarding the extent of violations, and recommendations to initiate a formal investigation.
Conduct interviews with complainant, witnesses, employers, State and local government agencies and other sources to obtain information regarding violations or noncompliance and develop leads and facts pertaining to the case to prove a violation or criminal intent exists.
Prepare required forms and notices; deliver to appropriate party regarding complaint and/or alleged violations following department policy and procedure; respond, review and discuss with complainant and respondent.
Develop case files and maintain case logs and reports; place evidence in case file along with chronological documentation regarding investigative steps taken and all contact made with complainant, respondent, witnesses and other sources; preserve and utilize evidence to develop final case reports and/or for future litigation.
Gather and review evidence such as business and financial records, service contracts, professional reports, bank statements, billing documents, sales transactions, client account records, personnel files and historical data pertaining to the suspected violation to develop trends, patterns and to support complaint; serve subpoenas or other legal documents as required.
Conduct audits on a periodic basis by either randomly selecting individual firms or business or as required by State law and reviewing business transactions for completeness, accuracy, and compliance with federal and/or State laws and regulations; evaluate internal procedures, operating methods, fiscal controls, and verify validity of financial statements and records; explain provisions and application of federal and/or State guidelines and discuss assessments, audit findings and recommendations.
Prepare required forms and notices and send to appropriate parties regarding complaint and alleged violations; review and discuss responses with supervisor and/or Attorney General.
Conduct research regarding program rules, court decisions, industry practices and standards, procedures and techniques to ensure compliance, and to develop or revise program regulations or policies; plan and coordinate investigations and audits to determine whether administrative and/or criminal action should be taken.
Prepare investigative and audit reports encompassing results of examination of accounting records, known violations, statement of facts, case summary, and exhibits of evidence, statements obtained from witnesses, conclusions and recommendations; review and submit reports for hearing or prosecution, and to impose fines and penalties; appear before the governing body or in a court of law to provide testimony as required.
Perform related duties as assigned.
Establish and direct investigative activities based on department goals and objectives.
Review and evaluate operational efficiency and compliance with program policy and procedures.
Directly supervise a staff of subordinate Compliance/Audit Investigators performing Medicaid, securities, real estate, mortgage lending, insurance, prevailing wage or workers’ compensation investigations and audits.
Assist in the planning and development of the program budget, internal policy and procedure, and the implementation or introduction of State legislation.
Work directly with the Program Administrator, agency heads, business representatives, violators, the complainant and judicial system regarding complaint resolution, regaining compliance, pursuing criminal prosecution, imposing administrative sanctions or penalties or addressing a hearings board or commission.