Job Description

Job description

Working Title : Workers Compensation Fraud Unit Investigator

Agency : Department of Insurance

Closing Date/Time: 08/26/2024

Salary: $6,339 - $9,178(Anticipated starting salary non-state $6,339/CBA language applies)

Job Type: Salaried /Full Time

County: Cook

Number of Vacancies: 2

Plan/BU: RC062

This position is a union position; therefore, provisions of the relevant collective bargaining agreement/labor contract apply to the filling of this position.

All applicants who want to be considered for this position MUST apply electronically through the illinois.jobs2web.com website. State of Illinois employees should click the link near the top left to apply through the SuccessFactors employee career portal.

Applications submitted via email or any paper manner (mail, fax, hand delivery) will not be considered.

Posting Identification Number 40713

*Answer all application questions thoroughly. DO NOT STATE "SEE RESUME".*

Position Overview

The Illinois Department of Insurance is seeking to hire a Workers Compensation Insurance Compliance Investigator. This position independently conducts investigations of alleged non-compliance with the criminal provisions of the Illinois Workers’ Compensation Act, Section 25.5; objectively and expertly analyzes evidence and makes recommendations regarding whether a violation of the Illinois Workers’ Compensation Act has occurred and whether criminal prosecution is warranted; prepares detailed reports of investigations, findings and violations of the Act; presents completed investigations to prosecutors from the Office of the Illinois Attorney General and State’s Attorney’s Offices; testifies in criminal proceedings; travels to perform investigations and to meet the needs of cases assigned. We invite all qualified candidates to apply to join our innovative team. We invite all qualified candidates to apply.

Essential Functions

1.Independently conducts thorough investigations of alleged non-compliance with Section 25.5 of the Workers’ Compensation Act by employers, medical providers, and others:

• Obtains, reviews, and analyzes documentary evidence, including medical records, payroll records, bank records, tax records and insurance records for evidence of fraud and non-compliance,
• Conducts interviews of complainants, witnesses, employers, medical providers, alleged violators, and others who may present information relative to the possible violation of the Worker’s Compensation Act under investigation,
• Engages in surveillance,
• Travels throughout the state to perform investigations.

2.Prepares detailed reports of investigations, findings, and violations of the Act, including expert analysis of complex and extraordinary issues related to workers’ compensation, for use in potential criminal proceedings:

• Makes objective recommendations regarding sufficiency of evidence to establish non- compliance, fraud, or other violations of law, as well as monetary damages and the potential for criminal prosecution,
• Creates and maintains organized investigative files while maintaining the security and confidentiality of all records and information.

3.Confers with supervisor in the conduct and reporting of complex investigations where evidence or supporting documentation is difficult to establish or obtain or where principles are of public prominence and media coverage may result.
4.Interacts with attorneys from the Office of the Illinois Attorney General, State’s Attorney’s Offices and other state and local prosecutors to present evidence of non-compliance with Section 25.5 of the Worker’s Compensation Act and explain complex and unusual aspects of the Illinois Workers’ Compensation Act in order to obtain criminal charges in investigations where non-compliance can be established by sufficient evidence:

• Provides testimony in hearings, trials, and other criminal proceedings,
• Works closely with other local, state, and federal law enforcement and regulatory agencies on cooperative investigations.

5.Assists other investigators in conducting interviews of individuals who have allegedly violated provisions of the Illinois Workers’ Compensation Act.
6. Attends and participates in formal and on-the-job training relating to new or revised statutes, judicial opinions, administrative rules, Department policies and procedures and investigative techniques.
7. Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

Minimum Qualifications

1. Requires a bachelor’s degree or the knowledge, skill, and mental development equivalent to the completion of four (4) years
of college, preferably with coursework in political science, criminal justice, public or business administration, accounting, or a related field.
2. Requires five (5) years of experience in insurance or utility complaint investigations, civil or criminal investigations,
or comparable investigatory experience.

Preferred Qualifications

1. Prefers ten (10) years of law enforcement experience with at least five (5) years of experience conducting investigations, including investigations of financial crimes.
2. Prefers thorough knowledge of effective investigative methods, techniques, and procedures.
3. Prefers experience and training regarding interviews and interrogation.
4. Prefers thorough knowledge of court procedures, practices, and rules of evidence.
5. Prefers working knowledge of legal and medical terminology.
6. Prefers ability to compile and summarize data and prepare records and reports in a clear and concise format.
7. Prefers experience preparing reports for use in criminal prosecutions.
8. Prefers ability to observe and record facts accurately about persons, objects, and events.
9. Prefers ability to establish and maintain effective working relationships with professional and lay groups, state and local government officials, employers, and the general public.

Employment Conditions

1. Requires the ability to pass background check.
2. Requires ability to travel in the performance of duties, with overnight stays as appropriate.
3. The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description.

About the Agency

The Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency. DOI has approximately 220 employees who are split between our Chicago and Springfield offices.

State of Illinois employees enjoy a robust benefit package, including:

• Health, Life, Vision, and Dental Insurance
• 13 Paid Holidays annually, 14 on even numbered years
• 10-25 days of Paid Vacation time annually - (10 days in year one of employment)
• 12 Paid Sick Days annually (sick days carry over from year to year)
• 12 Weeks Paid Maternity/Paternity Leave
• 3 Paid Personal Days annually
• Pension Plan
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• Flexible work schedules may be available, dependent upon position
• Tuition Reimbursement Program and Federal Public Service Loan Forgiveness Program eligibility

Visit for more information about our benefits.

Work Hours: M-F; 8:30am.-4:30 p.m.

Work Location: 122 S Michigan Ave, Chicago, Illinois, 60603

Agency Contact:

Email: DOI.HR@illinois.gov

Posting Group: Legal, Audit & Compliance

This position DOES NOT contain “Specialized Skills” (as that term is used in CBAs).

APPLICATION INSTRUCTIONS

Use the “Apply” button at the top right or bottom right of this posting to begin the application process.

If you are not already signed in, you will be prompted to do so.

State employees should sign in to the career portal for State of Illinois employees – a link is available at the top left of the Illinois.jobs2web.com homepage in the blue ribbon.

Non-State employees should log in on the using the “View Profile” link in the top right of the Illinois.jobs2web.com homepage in the blue ribbon. If you have never before signed in, you will be prompted to create an account.

If you have questions about how to apply, please see the following resources:

State employees: Log in to the career portal for State employees and review the Internal Candidate Application Job Aid

Non-State employees: on Illinois.jobs2web.com – click “Application Procedures” in the footer of every page of the website.

The main form of communication will be through email. Please check your “junk mail”, “spam”, or “other” folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:

• donotreply@SIL-P1.ns2cloud.com
• systems@SIL-P1.ns2cloud.com

Job Tags

Holiday work, Full time, Contract work, Local area, Flexible hours, Night shift,

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