Director of Special Investigations
1 week ago
Berkshire Hathaway Homestate Companies is a leading workers compensation insurance company dedicated to providing compassionate care to injured workers, superior service to our customers, and compelling opportunities for our employees. We pride ourselves on maintaining a small company feel and recognize that attracting and retaining high-quality talent is essential to our success.
Job Summary:The Director of Special Investigations is responsible for overseeing the Special Investigations Unit, ensuring strategic direction and implementation of effective prevention, detection, investigation, reporting, and recovery techniques to mitigate company exposure related to fraud. This individual will serve as a member of our Senior Leadership Team and work collaboratively with fellow Claims, Medical Management, Underwriting, Premium Audit, Finance, and Legal leadership to leverage resources and drive innovative approaches to reduce company losses.
Key Responsibilities:- Develops, directs, and evaluates investigative strategies, practices, policies, and performance standards to ensure desired outcomes are achieved in alignment with the department's mission and operational goals.
- Collaborates with key Senior Leadership to refine and maintain SIU best practices and processes to prevent, detect, investigate, and ensure timely reporting of suspected fraudulent activity.
- Creates and facilitates required fraud detection/prevention training to company staff, ensuring timely and thorough recordation of participation and completion.
- Provides investigative support for Lien Unit and external counsel as requested for litigation addressing issues associated with suspected fraud or abuse of billing and reporting practices.
- Leads efforts to partner with internal and external legal and investigative resources to ensure successful strategic outcomes at a competitive cost.
- Juris Doctor or minimum of Bachelors degree in Criminal Justice, Psychology, Sociology, Business Administration, Finance, or related major from an accredited college or university.
- Minimum of ten (10) years of relevant experience in special investigations within workers compensation, insurance fraud and abuse, or law enforcement, with a minimum of five (5) years of progressive managerial experience directing investigative personnel with complex workflows.
- One or more of the following certifications/licenses preferred: Active license in good standing to practice law in one or more jurisdictions, Certified Fraud Examiner (ACFE), Certified Insurance Fraud Investigator (CIFI), Chartered Property Casualty Underwriter (CPCU), Self-Insurance Certification (Claims/SIP).
Able to read, analyze, interpret, and advise regarding complex governmental regulations, legal opinions, claims laws and regulations, technical claims processes and procedures relating to fraud detection/prevention, and medical billing and reports.
Math and Reasoning Ability:Able to solve practical problems and deal with a variety of variables in situations where only limited standardization exists.
Technical and Computer Skills:Strong business and industry regulatory acumen complemented by claims adjusting knowledge, premium and medical billing familiarity, and industry best practices in risk management and fraud detection/prevention.
Travel:Occasional travel to other corporate offices or vendor locations required.
In accordance with the California Equal Pay Act, the pay scale for this job is $148,760 - $190,370. 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.
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