Director of Special Investigations

1 week ago

Sacramento, California, United States Berkshire Hathaway Homestate Company group Full time
About the Role

Berkshire Hathaway Homestate Companies is seeking a highly skilled and experienced professional to lead our Special Investigations Unit. As the Director of Special Investigations, you will be responsible for overseeing the strategic direction and implementation of effective prevention, detection, investigation, reporting, and recovery techniques to mitigate company exposure related to fraud.

Key Responsibilities
  • Develop, direct, and evaluate investigative strategies, practices, policies, and performance standards to ensure desired outcomes are achieved in alignment with the department's mission and operational goals.
  • Collaborate with key Senior Leadership (Claims/Medical Management, Underwriting, Premium Audit, Finance, Legal) to refine and maintain SIU best practices and processes to prevent, detect, investigate, and ensure timely reporting of suspected fraudulent activity.
  • Create and facilitate required fraud detection/prevention training to company staff, ensuring timely, thorough recordation of participation and completion is maintained and forwarded to proper regulatory authority.
  • Provide 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.
  • Lead efforts to partner with internal and external legal and investigative resources to ensure successful strategic outcomes at a competitive cost.
  • Compile data to monitor effectiveness of outcomes and implement changes as needed to accomplish fruitful, cost-effective results consistent with regulatory and industry standards/trends and corporate objectives.
Requirements
  • Juris Doctor or minimum of Bachelors degree in Criminal Justice, Psychology, Sociology, Business Administration, Finance, or related major from an accredited college or university; or, 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 (e.g., regulatory reporting); or, a combination of relevant education and industry training and experience.
  • One or more of the following 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.
  • Able to effectively present information and respond to questions from Executive management, vendor partners, legal counsel or authority, and the general public.
  • Able to respond to technical inquiries from internal and external sources, and regulatory agencies.
What We Offer

Berkshire Hathaway Homestate Companies offers a competitive salary range of $148,810 - $190,570, as well as opportunities for professional growth and development in a dynamic and collaborative work environment.

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