Claims Integrity & Compliance Officer - Workers' Compensation Division

Job Description

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 Ne...