Special Investigator / Claimant (Workers Compensation)

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.

Essential Responsibilities

• 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.

Required Qualifications

Desired Skills

What We Offer

$79,350 - $95,870 a year

This pay scale is an estimate of the salary range the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The actual salary may be above or below the range. The pay scale applies only to this position and only if it is filled in San Diego, California. The pay scale may be different for other positions or in other locations.

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 workplacesomething 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.