Special Investigator / Provider / Workers Compensation (Mid or Senior Level)

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Special Investigator to conduct investigations of suspected provider fraud referred from internal and external sources in compliance with regulatory requirements of assigned state(s). The ideal candidate will be mid-to-senior level in their career (5-10+ years of experience specializing in provider or health care fraud involving workers compensation claims, or in law enforcement, or a combination thereof) and adept in getting thoroughly vetted referrals to the Department of Insurance and applicable law enforcement and prosecutorial agencies, responding to requests for information, and providing testimony as called upon for those referrals being prosecuted. ESSENTIAL RESPONSIBILITIES

PERFORMS INVESTIGATIONS OF SUSPECTED PROVIDER FRAUD

• Thoroughly reviews referrals from internal and external sources, investigating all indication of suspected fraud.
• Triages and logs referrals; prioritizes accordingly.
• Conducts review of publicly available and subscription-based databases and documentation to identify provider ownership, leadership, and operations.
• Recommends and executes courses of action to move investigations to resolution, including directing the work of outside investigators retained to provide investigative assistance to the Company.
• Documents all investigations thoroughly and in a manner compliant with various state Departments of Insurance and other law enforcement agencies.
• Prepares detailed reports and presentations regarding ongoing investigations, including findings and recommendations.
• Prepares and submits suspected and documented provider fraud referrals to law enforcement and prosecutorial agencies when appropriate. Responds to requests for information.
• Stays abreast of case progress and responds to any additional requests for information; If required, provides deposition and / or courtroom testimony.

ADDITIONAL RESPONSIBILITIES

REQUIRED QUALIFICATIONS

LANGUAGE AND REASONING SKILLS

TRAVEL - Occasional travel one or more of the following required :

WHAT WE OFFER

$102,080 - $158,409 a yearThis 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 Walnut Creek, 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 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.