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Los Angeles County Metropolitan Transportation Authority

Job Specification

INVESTIGATOR, WORKERS' COMPENSATION INVESTIGATION

 

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Pay Grade
H1I ($62,316.80 - $77,875.20 - $93,454.40)
Job Summary

Supports Metro′s workers′ compensation claims administration by reviewing claims, data mining of social media, assisting in identification of information for conducting fraud investigations, and communicating findings and recommendations to assist with risk management claims mitigation, denial of fraudulent and abusive claims against Metro, and other related cases of employee misconduct.

Duties and Responsibilities
  • Plans, organizes, and conducts pre-investigation work on cases involving workers′ compensation fraud and abuse and other internal administrative investigations assigned
  • Conducts red flag assessment of injury/illness occupational claims
  • Conducts intensive social media and data mining reviews and gathering of information related to injured workers to determine appropriateness of intensive investigation and surveillance requirements to combat workers′ compensation fraud and abuse
  • Interacts with contractors when conducting and sub-contracting claims investigations
  • Presents investigative findings both orally and in writing for determination of the prospective merits of the case
  • Assists with preparation of suspected fraud case reporting 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 investigations
  • Conducts training for Claims Unit personnel and all other interested personnel with respect to fraud awareness and recognition
  • Recommends corrective action to resolve problems, abuses, and deficiencies that may exist
  • Works with appropriate prosecuting and law enforcement agencies, including State of California Department of Insurance, State of California Department of Industrial Relations′ Division of Workers′ Compensation, and local District Attorney′s Offices
  • Keeps direct supervisor informed on investigation progress and sensitive issues regarding cases
  • Complies with Metro′s bill paying standard to ensure sub-contracted investigations are paid in a timely manner
  • 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
  • Contributes to ensuring that the Equal Employment Opportunity (EEO) policies and programs of Metro are carried out


    May be required to perform other related job duties

Essential Knowledge, Skills and Abilities

Knowledge of (defined as a learned body of information that is required for and applied in the performance of job tasks)

  • Theories, principles, and practices of criminal rules of evidence, constitutional rights, search and seizure procedures, court procedures to be followed in criminal matters, formal hearings, and administrative actions
  • Applicable local, state, and federal laws, rules, and regulations governing insurance code, labor code, criminal investigations, and workers′ compensation fraud and abuse recognition
  • Metro policies and procedures
  • Specialized investigative techniques and intelligence gathering


Skill in (defined as the proficient manual, verbal, or mental utilization of data, people, or things)

  • Conducting workers' compensation fraud investigations
  • Preparing comprehensive reports and correspondence
  • Analyzing cases and identifying discrepancies
  • Analyzing situations, identifying problems, and recommending solutions
  • Exercising sound judgment and creativity in making conclusions
  • Communicating effectively orally and in writing
  • Interacting professionally with various levels of Metro employees and outside representatives


Ability to (defined as a present competence to perform an observable behavior or produce an observable result)

  • Compile and analyze complex and investigative data
  • Conduct administrative and criminal investigations
  • Understand, interpret, and apply laws, rules, regulations, policies, procedures, contracts, budgets, and labor/management agreements
  • Travel to offsite locations
  • Read, write, speak, and understand English
Minimum Qualifications

A combination of education and/or experience that provides the required knowledge, skills, and abilities to perform the essential functions of the position. Additional experience, as outlined below, may be substituted for required education on a year-for-year basis. A typical combination includes:

Education

  •  Bachelor's Degree in Criminal Justice, Law, Public Administration, Business Administration, Political Science, or a related field 


Experience

  • One year of relevant experience in either workers′ compensation investigation, administrative investigations, or other similar investigations relating to workers′ compensation fraud identification; some positions in this class may require specialized experience in area of assignment


Certifications/Licenses/Special Requirements

  • 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
Special Conditions

The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job. Metro provides reasonable accommodation to enable individuals with disabilities to perform the essential functions.

Working Conditions

  • Typical office situation
  • Close exposure to computer monitors and video screen
  • Exposure to hostile and armed criminal suspects
  • Work irregular hours, split shifts, weekends, holidays, or 24-hour-a-day on-call assignments
  • Work after designated regular hours in case of special assignments or emergencies
  • Local travel


Physical Effort Required

  • Sitting at a desk or table
  • Operate a telephone or other telecommunications device and communicate through the medium
  • Type and use a keyboard and mouse to perform necessary computer-based functions
  • Standing
  • Walking (distance 5' to 100')
  • Intermittently sitting, standing, stooping
  • Communicating through speech in the English language required
  • Good distance vision and/or depth perception to judge distances
 

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Job GroupJob Class CodeFLSA StatusDate OriginatedDate Revised
Non-Contract8029Exempt29-APR-0321-AUG-19

Disclaimer
This classification is at-will and the incumbent serves at the pleasure of the hiring authority when classified as an Intermittent, Emergency, or Temporary employee and/or is assigned to the Office of Inspector General (OIG) or Board Clerk's Office.

This job specification is not to be construed as an exhaustive list of duties, responsibilities, or requirements.

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