SPECIAL INVESTIGATOR

$65,040 - $106,320/Yr

State Compensation Insurance Fund

Full-time - Entry Level

Insurance Carriers and Related Activities

About the position

The Special Investigator position at the State Compensation Insurance Fund focuses on investigating provider fraud within the California Workers' Compensation system. The role involves conducting independent investigations, identifying fraud schemes, and collaborating with various stakeholders to analyze data and support law enforcement efforts. The investigator will maintain accurate case files and provide training and technical assistance as needed.

Responsibilities

• Conduct independent criminal, civil, and administrative investigations related to California Workers' Compensation Provider Fraud.
• Identify fraud schemes and develop investigation plans.
• Collect and organize large data sets to identify provider fraud.
• Learn and assess industry-recognized billing codes to identify provider fraud.
• Review and respond to complex law enforcement provider demands.
• Use data analytic techniques to extract insights from complex data sets and communicate findings to law enforcement partners.
• Obtain and verify evidence to support administrative actions and court proceedings.
• Maintain accurate and up-to-date investigation case files.
• Provide technical assistance and training to others.
• Cooperate with State, Federal, and local law enforcement agencies.
• Prepare clear, concise, and accurate documentation and reports detailing investigative activities.

Requirements

• Background/experience with the California Workers' Compensation Insurance system.
• Criminal/data analysis experience and skills.
• Prior investigation experience.
• Excellent oral and written communication skills.
• Strong analytical skills for investigating insurance provider fraud.
• Working knowledge of investigative techniques.
• Strong knowledge of researching databases.
• Ability to extract, organize, and analyze large data sets.
• Detail-oriented with strong organizational skills and time management abilities.
• Ability to work independently and collaboratively in a team-oriented environment.
• Proficiency with insurance-related programs such as claim adjusting, auditing, and underwriting software.
• Proficiency with Microsoft Office Products (Excel, PowerPoint, and Word).
• Possess a valid CA driver's license.

Nice-to-haves

• Experience in developing strong relationships with internal and external customers.
• Willingness to travel.

Benefits

• Health Benefits Program (CalPERS)
• Retirement (CalPERS)
• Employer Health and Consolidated Benefits Contributions
• Dental and Vision Insurance
• 401(k) and 457 Deferred Compensation Plans
• Employee Assistance Program
• Group Legal Services Insurance
• Holidays, Vacation/Sick/Other Paid Leave
• Flex Elect Reimbursement Program
• Wellness and Recognition Programs
• Alternate Work Schedules
• Transit Pass Program
• Tuition Reimbursement
• Dependent Scholarship Program
• Leadership Training
• Mentoring Program