Claims Investigator

Required Skills and Compentencies:

Candidates must demonstrate the ability to:

• Interpret and Implement Laws and Regulations: Understanding and application of federal and state unemployment insurance laws rules and regulations regarding benefit eligibility claims adjudication and fraud determinations.
• Investigate Claims: Utilization of investigative methods techniques and procedures applicable to fraud detection evidence gathering and fact verification.
• Understand Standard Payroll Processes: Review wage reporting systems and supporting documentation such as pay stubs and employer earnings records.
• Apply Mathematical Logic: Using mathematical logic reasoning to determine benefit eligibility overpayments and restitution amounts.
• Maintain Records: Identification retention and organization of documents electronic or otherwise related to an investigation.
• Utilizing computer systems: Operation of personal computer for investigation documentation record management and communication.
• Complete Complex Analysis: Claim data statements and evidence to identify patterns of error fraud or misreporting.
• Communication: Clear and effective in both oral and written form for reports correspondence and presentations.

MINIMUM QUALIFICATIONS

• Experience in interpreting and applying complex administrative rules federal and state laws and program policies.
• Demonstrated ability to communicate technical and legal information clearly to audiences with varying levels of understanding.
• Proven ability to maintain impartiality and professionalism when responding to claimants employers and other stakeholders.
• Proven ability to make independent well-reasoned and defensible decisions based on evidence and regulatory standards.
• Proficiency in planning prioritizing and completing work within established deadlines while managing multiple investigative cases.
• Formal education in business administration public administration criminal justice computer science or a closely related field may supplement relevant professional experience but is not a substitute for demonstrated skills and competencies in the areas noted above. Equivalent combinations of education and directly related experience will be considered.
  

HOW TO APPLY FOR THIS OPPORTUNITY:

A complete state application is not required; however you will need to initiate the application and attach the resume cover letter or other required documents at time of application to be considered for this position. Resume will auto fill the application but the application will not be scored or reviewed.

Failure to attach the cover letter and resume will result in your application being considered incomplete and will not be considered further. Materials submitted but not requested will not be considered in the selection process.

Tip: When attaching your resume cover letter or other required documents you must mark the attachments as RELEVANT or we will be unable to view your documents.

Required application materials:

• Cover Letter - Your Cover Letter should explain how your experience and education meet the identified Knowledge Skills and Abilities with examples that demonstrate your qualifications.
• Resume - include all work experience you have held that would help you qualify for this position including duties dates of employment.

Only online applications will be accepted. By applying online you can receive updates and monitor the status of your application.

All documents for Veteran or Disability preference must be received or date stamped by the closing date. You will receive an application confirmation email with instructions on acceptable preference documents and how to submit such documents.

If you need an accommodation with the application process please contact the HR office.

This position is located in the Unemployment Insurance Division.

Note: Employees for the State of Montana must reside within Montana. All applications and required application documents must be submitted through the MT Careers site at: STATEMENT:
Empowering all Montanans through work and opportunity.

DLI CORE VALUES:

• Responsiveness
• Respect
• Integrity
• Excellence
• Cohesiveness

Its about the people and the impact we make in our communities every day. We are proud of our open team-based supportive and collaborative work environments. Learn more about DLIhere.

BENEFITS:

Being able to enjoy the quality of life in the beautiful state of Montana is one of the benefits you will love about this opportunity! Our mountains waterways and open spaces provide not only beautiful scenery but year-round recreational opportunities including hiking camping biking fishing boating hunting skiing and snowmobiling. Montana boasts a high-quality education system and a variety of entertainment including fairs rodeos and theaters. Read more about our great state here.

See our other incredible benefits here. These are some of our benefits just to name a few:

• Work/life balance with hybrid schedules or partial telework may be available within the state of Montana.
• 38 paid days off a year including vacation sick leave and holidays.
• Military leave: Youll get up to 15 days of military leave with full pay.
• Longevity raises with continuous service as well as any negotiated market increases and state statutory raises.
• Health dental vision life insurance coverage flexible spending accounts EAP - clickhere to learn more.
• Free telehealth and access to free employee medical clinics through our medical plan - click here to learn more.
• Choice between two retirement plans with an employer contribution between 8.73% - 9.07% of your annual salary. A third optional 457(b) deferred compensation plan is also available. Click here to learn more.
• Public Service Loan Forgiveness- Employment with the State of Montana may qualify you to receive loan forgiveness- clickhere to learn more!
• Career progression training opportunities and room for professional growth.
• State employee discounts at various businesses across the state.

This position may be eligible for a statutory $1.00 an hour base pay increase effective on July 1 2026.

*This position may be covered by aVoluntary Employee Beneficiary Association (VEBA)

JOB DUTIES:

This position is responsible for the prevention detection and investigation of improper or fraudulent Unemployment Insurance (UI) benefit payments. The incumbent conducts investigations into paid claims adjudicates potential fraud cases and ensures compliance with federal and state laws governing benefit administration. Work is performed independently under general supervision and requires the application of sound judgment analytical reasoning and adherence to procedural and legal standards.

Essential Functions:

The Claims Investigator will:

• Prevent and detect improper benefit payments: by ensuring accurate claimant reporting of wages hours or earnings.
• Conduct investigations of paid UI claims: through interviews documentation review and electronic fact-gathering methods to establish accuracy and compliance.
• Adjudicate Claims: to determine whether claimant actions constitute fraud in accordance with applicable statutes regulations and program policy.
• Prepare written determinations and reports: by ensuring documentation is complete factual and legally defensible.
• Represent findings and defend investigative decisions: by presenting findings during administrative appeal hearings.
• Educate stakeholders: by providing guidance on UI laws policies and proper claims procedures.
• Support UI Benefit Operations: by completing assignments as assigned to ensure the integrity of UI benefits.