Job Description

Job Description and Duties

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 .

Working Conditions

Special Requirements

To be considered, you must provide a  fully completed STD 678 application, resume, and statement of qualifications via CalCareers. Resumes submitted in lieu of the STD 678 may not be accepted. Completed STD 678 must include duties performed, start and end dates, and hours worked per week for each position held.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

Benefits

Benefit information can be found on the CalHR website and the CalPERS website.

State Fund employees are eligible for a number of benefits. Our benefit package includes:

Health Benefits Program (CalPERS)

Retirement (CalPERS)

Employer Health and Consolidated Benefits Contributions

Dental, Vision

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

Alternate Work Schedules

Transit Pass Program

Tuition Reimbursement

Dependent Scholarship Program

Leadership Training

Mentoring Program

Background Investigation

Prior to employment with State Compensation Insurance Fund, a background investigation (BI) will be initiated.

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is required and must be included.
• Statement of Qualifications - In no more than two pages, using details from past or present experience, please address the following:
  • What are the steps you have taken when conducting a Workers' Comp Investigation case? Do these steps differ from case to case and if so, how and why would they differ?
  • Please discuss the different investigations and resources used when you conduct a Workers' Compensation Investigation. 
  Your name and JC-491770 must be present at the top of the page

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