Job Description

Apply for the SENIOR SPECIAL INVESTIGATIONS UNIT (SIU) INVESTIGATOR (RISK MANAGEMENT CLAIMS ADMINISTRATION) at Los Angeles Metro . This role supports Metro's Risk Claims Investigation administration by reviewing and analyzing claims for mitigation or red‑flagged suspicion of fraud, conducting highly complex investigations, and communicating findings and recommendations to assist with claim management and mitigation, denial of fraudulent and abusive claims against Metro, and other investigations of related employee misconduct. Base Pay Range $79,996.80/yr – $119,995.20/yr Metro’s mission is to provide a world‑class transportation system that enhances the quality of life for all who live, work, and play within LA County. Description Plans, organizes, and conducts complex investigations involving suspected workers' compensation fraud and abuse, insurance fraud and other internal employee related administrative investigations as assigned. Serves as project leader to contract firms when conducting and sub‑contracting claims investigations; investigations may include covertly following personnel. Conducts red‑flag assessment of injury/illness occupational claims and investigation of suspected falsified documents presented to Metro by employees or others. Conducts intensive data mining reviews of information and social media relating to injured workers' using multiple software data analysis to determine appropriateness of intensive investigation and surveillance requirements. Recommends corrective action to resolve problems, abuses, and deficiencies that may exist. Presents investigative findings both orally and in comprehensive professional reports for determination of the prospective merits of a investigation with Division or Labor Personnel, County Counsel and concurrence before local government and state level reporting. Prepares suspected case file for employee hearings or external filing and reporting of suspected fraud to the local District Attorney’s Offices, State Department of Insurance, and the State of California Fraud Division’s Anti‑Fraud Program. Testifies before the Workers’ Compensation Appeals Board, courts, or administrative hearings on results of claims or investigations. Conducts training for Claims Unit personnel and all other interested personnel with respect to fraud awareness and recognition. Provides guidance to staff regarding complex investigations and case development. Assists in preparing narrative, graphic, and statistical reports for executive and Board presentations, and internal review. Develops policies and procedures directed at reducing the incidence of claim fraud and abuse. Communicates and implements safety rules, policies, and procedures in support of the agency’s safety vision and goals; and maintains accountability for the safety performance of all assigned employees. Minimum Qualifications Education: Bachelor’s Degree in Criminal Justice, Law, Public Administration, Business Administration, Political Science, or a related field. Experience: Three (3) years of relevant experience in workers’ compensation investigations, administrative investigations, criminal investigations, fraud investigations, law enforcement, internal investigations, insurance fraud, risk management claims, or other similar investigations. Certifications/Licenses: A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job‑related essential functions. Designation or credentialing in workers’ compensation as a field investigator or data mining social media investigator preferred. Certified Professional in Fraud Identification (CPFI), insurance fraud investigator, private investigator, or law enforcement training in investigation preferred. Preferred Qualifications Experience handling claims related to investigation, general liability, torts, property casualty, workers’ compensation fraud identification, claims analysis, social media data mining, or related areas. Experience identifying and reporting insurance fraud, and collaborating with state or local law enforcement prosecution offices. Experience reviewing claims records and data related to workers’ compensation claims administration. Equal Employment Opportunity Metro is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, ancestry, national origin, gender, marital status, sexual orientation, religion, age, veteran status, or disability. Metro does not deny participation in the application process to anyone with prior justice system involvement, in line with Fair Chance hiring practices. All completed online Employment Applications must be received by 5:00 p.m. on the closing date. Late applications will not be considered. #J-18808-Ljbffr Los Angeles Metro

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