CLAIMS INVESTIGATOR I (2013)
CLAIMS INVESTIGATOR II (3129)
CLAIMS INVESTIGATOR III (3608)
I. NATURE OF WORK:
This is the entrance (I), experienced (II), and proficient (III) level of specialized
investigative work in the casualty insurance and criminal injuries compensation claims
field. Under general supervision, the employee is engaged in the investigation of
accident claims resulting from injuries to employees during the course of employment, or
claims resulting from personal injuries or death to victims during the commission of a
crime. The work involves the development of factual information for workers’
compensation or criminal injuries claims determination and litigation purposes.
Employees of this classification review assigned classes and develop and pursue
information leads for the clarification of facts submitted in support of injured employees’
claims for workers’ compensation or victims of crime claims for criminal injuries. This
involves contact with employees, employers, doctors, lawyers, hospital representatives,
witnesses, police officers, and others having knowledge of facts relating to specific cases.
As a result of these investigations, the employee prepares reports, including signed
statements, documentary evidence, pictures, etc. The employee includes in the reports
personal observations and opinions as to the validity of facts obtained and the advisability
of selecting witnesses to be subpoenaed for testimony purposes. These reports serve as a
basis for decisions on workers’ compensation or criminal injuries compensation awards.
The employee works under the general supervision of a claims supervisor or a
higher-level investigator. The employee may provide technical support and staff
assistance to various accident insurance claims examiners and/or members of the legal
staff. Employees of this class are afforded opportunity for the exercise of independent
judgment in the methods of conducting specific investigations and the extent of
investigation required as a result of facts developed during the course of the investigation.
Work effectiveness is evaluated through conferences, meetings, and the review of work
assignments. Work of this class does not involve supervision over the work of others.
Clerical assistance is provided as required.
II. EXAMPLES OF WORK: (Examples are illustrative only)
Reviews claim cases;
Clarifies employment status of claimants;
Plans course of investigation;
CLAIMS INVESTIGATOR I/II/III
Develops investigation leads;
Interviews employees, employers, doctors, lawyers, hospital representatives,
witnesses, police officers, and others;
Gathers facts to substantiate or deny the compressibility of claims;
Conducts surveillance of claimants’ activities as required;
Prepares comprehensive reports of facts gathered;
Investigates third party liability;
Evaluates the reliability of witnesses;
Suggests witnesses that may or may not provide suitable testimony;
May testify in court concerning the investigative aspect of a case;
May take photographs of accident sites and other evidence;
Performs other related duties.
III. REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Elementary (I), working (II, III) knowledge of the techniques of interviewing,
investigating and reporting; ability to plan the scope of investigation; to evaluate
competence of witnesses; to maintain harmonious working relationships with the legal
profession, medical profession, employees, employers and third parties; to gather and
report facts; to communicate effectively, to work independently; to exercise discernment
and judgment in the handling of public contacts; to prepare complete, comprehensive and
accurate reports; to develop information leads.
IV. MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS:
Education: Graduation from a standard high school or possession of a State high
school equivalence Certificate.
Experience: Four (I), five (II), six (III) years of experience in casualty, financial,
credit, or administrative investigations: law enforcement or licensed
detective work involving investigations; practice of law.
Notes: 1. Applicants may substitute education at an accredited college or
university at the rate of 30 semester credit hours for one year of
experience for up to four years of the required experience.
CLAIMS INVESTIGATOR I/II/III
2. Applicants may substitute additional experience as defined above for
the required high school education on a year-for-year basis.
V. LICENSES, REGISTRATIONS AND CERTIFICATES:
Employees may be required to possess a valid motor vehicle operator’s license.
DATE REVISED: July 1, 1979
DATE REFORMATTED: December 1, 2003
Class specifications are broad descriptions covering groups of positions used by various
State departments and agencies. Position descriptions maintained by the using
department or agency specifically address the essential job functions of each position.
Director, Division of Salary Administration
and Position Classification