Special Investigator/Claimant (Workers Compensation)

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Special Investigator to conduct investigations of suspected claimant fraud referred from internal and external sources. This individual will draft referrals of suspected fraud to the Department of Insurance and applicable law enforcement agencies, respond to government agencies' requests for information, and testify as required.

• Review referrals from integral anti-fraud personnel for suspected fraud and evaluate the presence of red flags and indications of suspected fraud.
• Conduct review of internal, subscription based and publicly available databases and documentation to identify appropriate resources and investigative strategies.
• Review evidence generated by outside vendors including surveillance video, investigative reports, background reports and other documentation for suspected fraud, and ensure accuracy and completeness for submission to law enforcement.
• Possess and maintain a clear understanding of investigative techniques and the laws pertaining to insurance claims and mandated fraud reporting as well as a general knowledge of legal principles, civil and criminal, pertinent to the investigation of claim activity.
• Document all SIU investigations thoroughly and in a manner compliant with various state departments of insurance and other law enforcement agencies.
• Prepare and submit suspected and documented fraudulent claim referrals timely.
• Maintain an active caseload list and diary of SIU Investigations assigned by SIU Director and manage the workload to maximize capacity.
• Appropriately uses data analysis to detect fraud patterns and trending schemes.
• Provide support to integral anti-fraud personnel to identify and provide training regarding various subjects to increase fraud awareness.
• Assist with development and presentation of annual SIU training mandated by the Department of Insurance from numerous jurisdictions, as well as identification and development of areas of opportunity for additional training for Claims staff to ensure timely, quality referrals.
• Identify, establish and cultivate external relationships with industry contacts and law enforcement involved in fraud investigation, detection and prevention.

• EDUCATION: Minimum of High School diploma or equivalent certificate required. Bachelor's degree from an accredited four-year college or university preferred.
• EXPERIENCE. Minimum of 3 years of workers compensation indemnity claims adjusting experience required.
• SKILLS: Proficient in Microsoft Office suite of applications and ability to demonstrate proficiency on information-aggregation databases and vendor software programs.
• LANGUAGE ABILITY: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations, to construct reports, business correspondence, and procedure manuals. Ability to effectively present information and to respond from inquiries from internal and external sources.
• MATH AND REASONING ABILITY: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form with several abstract and concrete variables.

• ANALYTICAL THINKING: Ability to analyze information to understand issues, identify options, and support sound decisions. Actively anticipates outcomes of various scenarios.
• HANDLING DIFFICULT SITUATIONS: Ability to handle sensitive or difficult issues with grace and confidence. Remains clear-headed and focused and inspires other to do the same. Remains objective in the face of strong emotions.
• RESULTS DRIVEN: Understands that intentions, activities, and results are not the same. Ability to plan, organize, and implement steps to complete investigations to meet established goals. Expects that obstacles will occur and refuses to use them as an excuse for not achieving results.
• TIME MANAGEMENT: Effectively manages time in order to accomplish work. Appropriately prioritizes tasks according to importance and time constraints. Always aware of the status of assigned tasks. Regularly keeps other informed of task status.
• INITIATIVE: Handles situations and issues proactively. Anticipates and takes action to avoid an imminent problem. Suggests ways to achieve better results or add value beyond the current situation.

• Work-Life Balance
• Work From Home Program (up to 2 days per week upon eligibility)
• Modernized Historical Setting in East Sacramento
• Free Lot Parking
• Paid Time Off
• Paid Holidays
• Retirements Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Accident and Critical Illness Insurance
• Flexible Savings Accounts
• Paid Community Volunteer Day
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program

ABOUT US

With more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.

At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We’ve created an approachable and collaborative atmosphere. Here you’ll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.