CLAIMS INVESTIGATOR TRAINEE
There is no civil service exam for Claims Investigator Trainee. As a non-competitive state title, it is filled on the strength of meeting the listed qualifications.
On paper it calls for a bachelor's degree, though the specification lets enough relevant experience stand in for the degree. Pay on the FY 2027 schedule runs $53,282 to $55,691.
How to apply
This title is not filled by examination — agencies appoint directly.
See every real route in, and where to apply. We don't track live vacancies.
See where to apply for this title →Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under the close supervision of a Claims Investigator 3, Claims Investigator 4, or other supervisory official in a state department or agency, learns to conduct investigations of claims arising from State employee employment-related injuries and disease; accidents resulting in damage to state owned property; and/or third party claims for bodily injury and/or property damage arising from the use or operation of state owned properties and/or the activities of state employees; or assigned to an office location, learns to investigate, evaluate and process claims arising out of workers compensation, negligence, tort and/or claims for ownership of abandoned real, personal, tangible and non-tangible property accrued to the state, other claims involving state employees and/or state owned property; as well as other types of negligence or tort claims made against the state; learns to investigate fraud and disaster-related claims; does other related duties as required.
Examples of work
Under close supervision, as a trainee and productive worker: Learns to investigate and obtain complete information in connection with claims arising out of workers compensation, tort, contract, negligence, and personnel matters involving state employees and state-owned property, as well as other types of negligence or tort claims encountered by the state. Learns to investigate and obtain complete information in connection with claims arising from abandoned, real, personal, tangible and non-tangible property that has accrued to the state. Learns to examine claims for authenticity, authorizes payment of benefits, and recommends fraud investigations as needed. Learns to review claims that are served by writs to the State of New Jersey by the Division of Taxation to levy on specific individuals in the collection of funds being held by the Unclaimed Property Administration. Learns to assist in the conduct of routine fraud investigations for workers compensation, tort, contract, negligence, and/or unclaimed property claims. Learns to assist in the investigation and review of traumatic injury claims. Learns to analyze the impact of comorbidities (pre-existing conditions) and psychosocial issues such as post-traumatic stress disorder. Assists in the investigation and review of disaster-related claims, in accordance with Federal Emergency Management Agency (FEMA) and New Jersey Office of Emergency Management policies, practices, and procedures. Contacts debtors, attorneys, and representatives of insurance companies with reference to settlement of negligence claims. Contacts representatives of claimants such as attorneys, administrators, executors, and guardians in order to resolve claims. Visits and interviews physicians, professional specialists, state employees, police officers, and others who have or may have pertinent data; records their testimony. Visits scenes of accidents, makes sketches, takes photographs, and obtains police reports and medical and other data needed in the processing of all claims made by and against the state, which is to be used, when necessary, in litigated cases involving property damage claims; may assist in accident prevention analysis to determine if safety training is required. As assigned, assists in the review of Medicare's conditional payments made on behalf of injured parties. Makes abstracts of hospital records, obtains X-rays and medical reports, and compiles other data needed to assist in the preparation and trial of cases. Attends informal hearings, meetings, and conferences as required. Makes arrangements for needed physical and medical examinations of injured state employees as required. Develops working knowledge of new and emerging types of unclaimed property. May participate in public outreach activities to promote awareness to the citizenry about the availability of unclaimed property. Attends court hearings in connection with accidents involving state property, equipment, or personal injury to state employees. When required, acts as a witness in court proceedings. Prepares clear, sound, accurate, and informative written reports. Maintains essential records and files of the bureau or unit. Will be required to learn how to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
Knowledge, skills and abilities
Ability to learn the appropriate laws, rules, regulations, policies, procedures, and standards of the investigative bureau or unit assigned as they apply to claims work. Ability to learn negligence law, tort law, contract law, and rules of evidence, or abandoned property law. Ability to learn medical and legal terms commonly used in claims work, including terminology specific to the Medicare program. Ability to learn the techniques of interviewing and their application to specific claims situations. Ability to learn the anti-fraud methodologies, investigation techniques, and software. If assigned to the Division of Risk Management, ability to learn Title 34 (the Workers' Compensation Statute), and Title 59 (the Tort Claims Act). If assigned to the Unclaimed Property Administration, ability to learn Title 46 of the New Jersey Statutes and Title 17:18 of the New Jersey Administrative Code. Ability to apply the regulations, policies, and procedures of the investigative bureau or unit in the processing of claims against the state for injury and/or damage. Ability to apply regulations, policies, and procedures of the abandoned property unit in the processing of claims. Ability to understand, analyze, and interpret basic law and regulations to persons of varying education, economic, and ethnic backgrounds. Ability to organize assigned investigation and claims work and to develop effective work methods. Ability to secure needed information to select pertinent data and prepare clear, sound, accurate, and informative reports of investigations which shall include documentary evidence. Ability to communicate with physicians and other members of the medical profession, hospital and clinic staff, police officers, claimants, attorneys, key witnesses, and others and to obtain such oral and other testimony and evidence, including copies of medical reports and records, as required. Ability to work with external stakeholders, including Medicare, the Federal Emergency Management Agency, and the New Jersey Office of Emergency Management, on various types of claims. Ability to continuously monitor claims for indicators of fraud. Ability to participate in outreach activities. Ability to acquire knowledge about new and emerging types of unclaimed property. Ability to review and analyze case records, testimony, statements of witnesses, and other information. Ability to locate sources of information. Ability to work effectively with claimants, witnesses, lay and professional persons, police officers, and with that portion of the public interested in or concerned with the work of the investigative bureau or unit. Ability to act as a witness and to present testimony in court actions. Ability to prepare detailed reports of claims matters containing findings, conclusions, and recommendations. Ability to maintain essential records and files. Ability to learn how to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand and communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible if they can perform the essential functions of the job with or without reasonable accommodation. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible. ADVANCEMENT : Appointees who successfully complete the twelve (12) month training period will be eligible for advancement to the title(s) for which they have been trained: Claims Investigator 1 (). The inability of an employee in this title to attain a level of performance warranting advancement to the title listed above shall be considered as cause for separation.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. Applicants must meet one of the following or a combination of both experience and education. Thirty (30) semester hour credits are equal to one (1) year of relevant experience. Four (4) years of professional experience in workers compensation, negligence or claims investigation. OR Possession of a bachelor's degree from an accredited college or university. "Professional experience" refers to work that is analytical, evaluative, and interpretive; requires a range of basic knowledge of the profession's concepts and practices; and is performed with the authority to act and make accurate and informed decisions.