Special Investigator (Claimant/Workers Compensation)

WHAT WE'RE LOOKING FOR

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Special Investigator. This experienced professional will conduct investigations of suspected Claimant fraud referred from internal and external sources in compliance with applicable laws and regulations of various states and will draft suspected fraud referrals to Departments of Insurance and law enforcement agencies, respond to government agencies' requests for information, and testify as required.

• Reviews referrals from internal and external sources for suspected fraud and evaluates the presence of red flags and indications of suspected fraud.
• Independently completes investigations in accordance with legal requirements and best practices, to include: (1) conducting reviews of internal, subscription-based and publicly available databases and documentation to identify appropriate resources and investigative strategies; (2) reviewing evidence generated by outside vendors, including surveillance video, investigative reports, background reports, and other documentation for suspected fraud, and ensuring accuracy and completeness for submission to law enforcement; (3) possessing and maintaining a clear understanding of investigative techniques and the laws pertaining to insurance claims and mandated fraud reporting, as well as general knowledge of legal principles, civil and criminal, pertinent to the investigation of claim activity; (4) documenting all SIU investigations thoroughly and in a manner compliant with various State Departments of Insurance and other law enforcement agencies; (5) preparing and submitting suspected and documented fraudulent claim referrals timely.
• Maintains an active caseload list and diary of SIU investigations assigned by management and efficiently manages workload to maximize capacity.
• Conducts data analytics to detect fraud patterns and trending schemes.
• Assists 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 internal partners to ensure timely, quality referrals.
• Identifies, establishes and cultivates 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. Bachelors degree from an accredited college or university preferred.
• EXPERIENCE: Minimum of three years of workers compensation indemnity claims adjusting experience required. Prior investigative experience a plus.
• COMPUTER SKILLS: Possess proficiency of Microsoft Office/365 suite of applications; demonstratable proficiency on information-aggregation databases; able to master proprietary and vendor software.

• ANALYTICAL THINKING: Able to analyze and synthesize information to understand issues, identify options, and support sound decisions. Leverages research and data to solve challenges and make decisions. Uses intuition and experience to complement data.
• TIME MANAGEMENT/SENSE OF URGENCY: Effectively manages time in order to accomplish work. Appropriately prioritizes tasks according to importance and time constraints. Is always aware of the status of assigned tasks. Regularly keeps others informed of task status. Uses project management systems and calendars to keep organized.
• COMMUNICATIVENESS: Consistently and effectively communicates with a wide spectrum of people at all levels. Is proactive in sharing important information; shares needed information in a timely manner. Is easily accessible, approachable, and open.
• RESULTS DRIVEN: Plans, organizes and implements projects to meet established goals. Articulates vision and steps for achievement. Achieves results within established timelines. Understands and demonstrates that intentions, activities and results are not the same. Expects that obstacles will occur and refuses to use them as an excuse for not achieving results.
• INITIATIVE: Handles situations and issues proactively. Anticipates and takes action to avoid an imminent problem. Suggests ways to add value beyond the current situation as appropriate.
• TECHNICAL SKILLS: Pursues training and development opportunities. Strives to continuously build knowledge and skills and shares expertise with others.

• Manageable Caseloads
• Work-Life Balance
• Hybrid Schedule (Option to Work From Home 2 Days Per Week)
• Onsite Collaboration with Adjusting Staff
• 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.

DISCLAIMERS

The Work from Home Program is subject to certain eligibility requirements.

The salary range is an estimate. The actual salary may be above or below the range depending on experience, skill, and education.