State Compensation Insurance Fund, Special Investigations Unit, is searching for a Worker’s Compensation Special Investigator. Candidates should have background/experience with the California Workers’ Compensation Insurance system, criminal/data analysis experience/skills set, and prior investigation experience. The Special Investigator will be responsible for Injured Worker and Premium Investigations.
Under the direction of a Supervising Special Investigator, this position will:
• Conduct independent criminal, civil, and or administrative investigations with an emphasis on CA Worker’s Compensation Fraud to detect or verify suspected violations or provisions of CA Workers’ Compensation Insurance, Federal, State, and/or local laws, rules, and regulations
• Identify fraud schemes and develop investigation plans
• Work with stakeholders across the organization to collect and organize large data sets to identify workers’ compensation fraud
• Knowledge of industry recognized databases to identify suspected fraud
• Review and respond to complex law enforcement demands
• Use data analytic techniques to extract insights and knowledge from complex data sets and communicate findings to law enforcement partners in a clear and effective way
• Obtain and verify evidence to support administrative actions, court proceedings, and/or prosecution
• Maintain accurate up to date investigation case files
• Provide technical assistance and training to others
• Cooperate with State, Federal and local/county law enforcement agencies
• Prepare clear, concise, and accurate documentation and reports detailing investigative activities and other related duties
Desirable Skills:
• Experience working with outside Private Investigators and Law Enforcement
• Prior Workers Compensation Insurance experience in claims, underwriting and/or auditing
• Strong knowledge of extracting, organizing, and analyzing large data sets from multiple data points
• Detail-oriented with strong organizational skills, time management abilities, able to work well under deadlines in a changing environment while prioritizing multiple tasks effectively and concurrently
• Demonstrate ability to effectively work independently and within a collaborative team-oriented environment using sound judgement in decision making
• Demonstrate proficiency with Insurance related programs such as: claim adjusting, auditing and underwriting software programs
• Demonstrate ability to develop strong, positive relationships with both internal and external customers
• Demonstrate proficiency with Microsoft Office Products (Excel, PowerPoint, and Word)
• Willingness to travel
• Possess a valid CA driver’s license
You will find additional information about the job in the Duty Statement.