Investigative Specialist

Insurance • Wake County, NC

1d • Hybrid

About The Position

The mission of the North Carolina Department of Insurance is to promote a stable insurance market through unbiased regulation and to protect the lives and property of every citizen in all 100 counties while fostering superior, user-friendly service, courtesy, and respect. Our agency licenses insurance agents, adjusters, bail bondsmen and more, along with investigating fraud matters involving insurance consumers and any entity or individual regulated by the Department. In an ever-changing environment, it is the vision of the Department of Insurance to maintain the stabilization of the insurance industry in order to provide more products, competitive prices and consumer protection.

The North Carolina Industrial Commission is vested by the General Assembly with exclusive and original jurisdiction to adjudicate and administer the North Carolina Workers’ Compensation Act. The Industrial Commission processes over 65,000 workers’ compensation injury reports and claims filed annually under the Act. This responsibility includes overseeing and providing for the trial of contested cases, as well as administering non-contested cases. Workers who are injured by accident on the job or who contract an occupational disease receive disability and medical benefits as ordered by the Industrial Commission. The Industrial Commission is also a court of original jurisdiction for litigating tort claims against the State under the North Carolina State Tort Claims Act. Additionally, the General Assembly has mandated that the Industrial Commission provide an adjudicatory process for claims filed under the Childhood Vaccine-Related Injury Program and claims filed under the Compensation to Persons Erroneously Convicted of Felonies Act. It acts as a court of exclusive and final jurisdiction for death claims arising under the Public Safety Employees’ Death Benefits Act made by dependents of law enforcement officers, firefighters, rescue squad workers, and civil air patrol members. Each of these adjudicatory systems requires the administration of contested and uncontested claims, the review of agreements, and the supervision of the payment of benefits.

Investigative Specialist (65020585) Salary Recruitment Range $43,267 -$55,000 Salary Grade: NC 10 This position currently qualifies for a hybrid telework option with routine office and remote workdays. The posting will close at 11:59 p.m. the night before the closing date.

The Criminal Investigations Section of the North Carolina Industrial Commission operates as a law enforcement agency and is responsible for conducting criminal investigations into cases of suspected workers’ compensation fraud, employee misclassification, and violations related to workers’ compensation claims involving employees, employers, insurers, health care providers, attorneys, and vocational rehabilitation providers. Criminal Investigators investigate all criminal complaints filed with the Industrial Commission regarding failure of employers to maintain workers’ compensation insurance (N.C. Gen. Stat. § 97-94(d), fraud on the part of employees with regard to the collection or obtaining of workers’ compensation benefits (N.C. Gen. Stat. § 97-88.2), fraud on the part of employers with regard to payment or collection of workers’ compensation premiums from employees’ salaries (N.C. Gen. Stat. § 97-21), medical payment fraud (N.C. Gen. Stat. § 97-88.3), and any other claims arising out of violations of Chapter 97 by employees or employers. The Criminal Investigations Section works with judicial officials and other law enforcement agencies throughout the State to resolve the above investigations in criminal court. The Criminal Investigations Section collaborates with the Industrial Commission’s Employee Classification Section to proactively identify and investigate employee misclassification, thus helping ensure compliance with the North Carolina Employee Fair Classification Act and North Carolina Workers’ Compensation Act.

The primary purpose of the Investigative Specialist is to provide comprehensive administrative support to the Industrial Commission’s Investigators and the Division Chief. The Investigative Specialist is the primary point of contact for the Division, documenting formal complaints received via U.S. Mail, phone, or email and synthesizing pertinent documents and other information received from complainants, other State agencies, attorneys, insurance providers, and other Industrial Commission sections and divisions. The Investigative Specialist researches, collects, and analyzes information from databases and public records and presents findings and recommendations to the Investigators and Division Chief. Among other things, the Investigative Specialist carefully analyzes workers’ compensation insurance coverage information to help determine whether a violation of N.C. Gen. Stat. §97-93 has occurred, and the Investigative Specialist also carefully analyzes information received through the Employee Classification Application to help determine whether an employer may be misclassifying employees as independent contractors. The Investigative Specialist supports the Industrial Commission’s Investigators with criminal investigations by preparing case files, organizing documentary evidence, and creating trial exhibits. The Investigative Specialist is required to utilize the Industrial Commission’s approved intake system for the Criminal Investigations & Employee Classification Division so that cases reported can be easily tracked and accessed by all authorized employees. Additionally, the Investigative Specialist is required to follow all relevant Industrial Commission procedures for the uploading and filing of documents associated with Criminal Investigations & Employee Classification Division cases. The Investigative Specialist assists the Division Chief with compiling accurate statistical information, ensuring compliance with the Division of Criminal Information/Criminal Justice Information System, CJLEADS, and the Investigative Specialist serves as the Division’s Certified Notary Public. To perform the position duties, the Investigative Specialist must have a working knowledge of relevant North Carolina criminal and civil statutes (including but not limited to the North Carolina Workers’ Compensation Act and the Employee Fair Classification Act), relevant Industrial Commission rules, and an understanding of Industrial Commission procedures, the North Carolina criminal justice system as it pertains to criminal investigations, and workers’ compensation insurance industry terms, concepts, and principles.

Requirements

• Demonstrated experience researching, collecting, and analyzing information from different information sources.
• Demonstrated experience reviewing and analyzing information to determine the accuracy or sufficiency of the information.
• Demonstrated experience understanding, interpreting, or applying provisions of a statute, rule, or policy and procedure to a case or situation.
• High school diploma or General Educational Development (GED) diploma and two years of related administrative experience; or equivalent combination of education and experience.
• Bachelor’s degree from appropriately accredited institution and one year of experience related to the area of assignment; or an equivalent combination of training and experience.
• Must pass a background investigation.
• Obtain certification as a DCI Terminal Operator pursuant to 12 NCAC 04E .0402 with the Federal Bureau of Investigation Criminal Justice Information System and State Bureau of Investigation Division of Criminal Information.
• Obtain certification as a Certified Notary in North Carolina.

Nice To Haves

• Working knowledge of relevant North Carolina criminal and civil statutes (including but not limited to the North Carolina Workers’ Compensation Act and the Employee Fair Classification Act).
• Working knowledge of relevant Industrial Commission rules.
• Understanding of Industrial Commission procedures.
• Understanding of the North Carolina criminal justice system as it pertains to criminal investigations.
• Understanding of workers’ compensation insurance industry terms, concepts, and principles.

Responsibilities

• Provide comprehensive administrative support to the Industrial Commission’s Investigators and the Division Chief.
• Serve as the primary point of contact for the Division, documenting formal complaints received via U.S. Mail, phone, or email.
• Synthesize pertinent documents and other information received from complainants, other State agencies, attorneys, insurance providers, and other Industrial Commission sections and divisions.
• Research, collect, and analyze information from databases and public records and present findings and recommendations to the Investigators and Division Chief.
• Analyze workers’ compensation insurance coverage information to help determine whether a violation of N.C. Gen. Stat. §97-93 has occurred.
• Analyze information received through the Employee Classification Application to help determine whether an employer may be misclassifying employees as independent contractors.
• Support the Industrial Commission’s Investigators with criminal investigations by preparing case files, organizing documentary evidence, and creating trial exhibits.
• Utilize the Industrial Commission’s approved intake system for the Criminal Investigations & Employee Classification Division.
• Follow all relevant Industrial Commission procedures for the uploading and filing of documents associated with Criminal Investigations & Employee Classification Division cases.
• Assist the Division Chief with compiling accurate statistical information.
• Ensure compliance with the Division of Criminal Information/Criminal Justice Information System, CJLEADS.
• Serve as the Division’s Certified Notary Public.

Benefits

• 12 Annual paid Holidays
• North Carolina State Health Plan administered by AETNA
• Supplemental Benefits including: Flexible Spending Accounts, Accident Insurance, Cancer & Specified Disease, Critical Illness, Dental and Vision
• NC State Retirement (TSERS)
• WeSave Employee Discounts

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level