Job Description

Job Description and Duties

This position may be filled at one of the following State Fund locations: Bakersfield, Eureka, Fresno, Glendale, Pleasanton, Redding, Riverside, Rohnert Park, San Diego, Sacramento, Stockton or Vacaville.

State Compensation Insurance Fund, Special Investigations Unit, is hiring a Special Investigator for the Worker’s Compensation Provider Fraud Team. 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 Provider Fraud 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 Provider 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 within provider fraud and develop investigation plans.
• Work with stakeholders across the organization to collect and organize large data sets to identify provider fraud.
• Ability to 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 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:

• Excellent communication skills both oral and written with strong analytical skills to investigate insurance provider fraud.
• Working knowledge of investigative techniques
• Strong knowledge of researching databases is required.
• 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.

New to state candidates will be hired into the minimum salary of the classification or minimum of the alternate salary range when applicable. Placement to alternate salary range may be based on education or experience identified in your state application.

You will find additional information about the job in the .

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

Additional Documents

Special Requirements

Application Instructions

Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.

Final Filing Date: 10/30/2024

Who May Apply

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply.

Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

How To Apply

Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:

Address for Mailing Application Packages

You may submit your application and any applicable or required documents to:

State Compensation Insurance Fund

Mailing Address

Attn: JC-453715 CA

PO BOX 659015

Sacramento , CA 95865

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

State Compensation Insurance Fund

Talent Acquisition/Staffing

JC-453715 CA

2275 Gateway Oaks Drive

Sacramento , CA 95833

08:00 AM - 05:00 PM

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.
• Degree and/or School Transcripts
• Statement of Qualifications - In no more than one page, please provide numbered responses to the following questions:
  1. Tell us an experience where investigative techniques were utilized in the course of your job and what was the outcome. 
  2. Tell us about your ability and/or skill sets when analyzing large amounts of data.

Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Benefits

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  

Contact Information

The Human Resources Contact is available to answer questions regarding the position or application process.

Human Resources Contact:
Carl Agulo
(800) 499-8668
CAgulo@scif.com

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:
Rosa Gil-Robles
(800) 499-8668

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Background Investigation

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

Job Tags

Holiday work, Permanent employment, Full time, Local area, Flexible hours,

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