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SIU Investigator: Provider Fraud

  • Location: San Diego OR Sacramento
  • Sector: Legal
  • Employment type: Permanent
  • Date posted: Jan 2, 2019
  • Closes: Jan 30, 2019
NOTE: BHHC does not conduct interviews via social media (e.g. Google hangout, LinkedIn, etc.). Please be aware that any such contact is fraudulent and we advise that you not provide any personal information.

As a member of the Berkshire Hathaway group of insurance companies, we offer outstanding opportunities for professionals interested in working with a successful company. We offer unparalleled financial strength, stability and “large company” benefits, in addition to an exciting, friendly, “small company” atmosphere.

Berkshire Hathaway Homestate Companies has an opening in our Sacramento OR San Diego office locations for a Special Investigations Unit Investigator. SIU Investigator will investigate fraud via referrals from integral anti-fraud personnel for all states to address medical provider fraud. The SIU investigator may also investigate premium and claimant fraud. SIU investigator will work with internal Units and external vendors to ensure investigations are clearly defined and fully developed to maximize fruitful results, and that external vendors provide quality work responsive to the referral. SIU Investigator will conduct and review investigations to ensure compliance with laws and regulations of various states, draft suspected fraud referrals to Departments of Insurance and law enforcement agencies for criminal prosecution, prepare documented referrals to the agencies, and respond to government agencies’ requests for information and testify as required.

  • Reviews referrals from integral anti-fraud personnel for suspected fraud and evaluates the presence of red flags and indicia of suspected fraud;
  • Independently completes investigation in accordance with legal requirements, core performance values and best practices with minimal direction which includes the following activities:
  • Conducts review of internal, subscription-based and publicly-available databases and documentation to identify appropriate resources and investigative strategies;
  • Reviews evidence generated by outside vendors including surveillance video, investigative reports, background reports and other documentation for suspected fraud, and ensures accuracy and completeness for submission to law enforcement;
  • Possesses and maintains a clear understanding of investigative techniques and the laws pertaining to insurance claims and mandated fraud reporting as well as a general knowledge of legal principles, civil and criminal, pertinent to the investigation of claim activity;
  • Documents all SIU investigations thoroughly and in a manner compliant with various state departments of insurance and other law enforcement agencies
  • Prepares and submits suspected and documented fraudulent claim referrals timely, and
  • Responds to agency requests for information promptly. 
  • Maintains an active caseload list and diary of SIU Investigations assigned by SIU Director and manages the workload to maximize capacity
  • Conducts data analytics to detect fraud patterns and trending schemes;
  • Provides support to integral anti-fraud personnel to identify and provide training regarding various subjects to increase fraud awareness;
  • Attends SIU training mandated by the Department of Insurance from numerous jurisdictions;
  • Identifies, establishes and cultivates external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention. 
  • Education: Graduate of an accredited college or university is preferred or an equivalent combination of education and experience;
  • Experience: Possess minimum three years SIU industry or law enforcement experience;
  • Language Ability: Able to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations, to write reports, business correspondence and procedure manuals, to effectively present information, and to respond to inquiries from internal and external sources.
  • Reasoning Ability: Able to define problems, collect data, establish facts, and draw valid conclusions, and is able to interpret an extensive variety of technical instructions in mathematical or diagram form with several abstract and concrete variables.
  • Technical Skills: Possess knowledge of office operations, workflow analysis, and current technologies in telecommunications, data entry and file management.
  • Computer Skills: Possess proficiency of Microsoft Office products including Word, Excel, Outlook and Powerpoint, and is knowledgeable on information-aggregation databases and vendor software programs.
  • Health and wellness – low premiums for medical, dental and vision coverage, FSA and EAP benefits
  • Company paid Life, Disability and ADD benefits
  • Employee Retirement Savings Plan with employer match up to 5 percent of compensation
  • Generous Paid Time Off and Holidays
  • Education Assistance Reimbursement
  • Recognition and Rewards Programs
  • Company Store
  • Discounts across Berkshire Hathaway Inc. companies such as GEICO, See’s Candies, etc.
The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Sacramento, Pasadena, Omaha, Philadelphia, St. Louis, Atlanta, and Dallas.

As a member of the Berkshire Hathaway Insurance Group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating for the last 10 consecutive years. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds security and makes us one of the best brands in the marketplace.
We value each individual and recognize that attracting and retaining high-quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands-on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.

Within the last six years, BHHC Workers Compensation has seen significant growth, and we’re continuing to grow as we build one of the largest Workers Compensation companies in the country – join us!

This organization participates in E-Verify. For more information on E-Verify, please contact DHS: 888.897.7781 www.dhs.gov/E-Verify.

We will consider for employment qualified applicants with criminal histories as required by local ordinance. Additionally, no applicant will be denied employment solely on the grounds of conviction of a criminal offense except to the extent necessary to obtain a necessary license or to comply with The Violent Crime Control and Law Enforcement Act of l994, which prohibits the employment by an insurance company of persons convicted of certain crimes, unless a waiver is obtained.

To apply click below 

San Diego: https://newton.newtonsoftware.com/career/JobIntroduction.action?id=8a7887a8679bbd5001679fb7cd265b5c&source=WorkersCompCentral
Sacramento: https://newton.newtonsoftware.com/career/JobIntroduction.action?id=8a7887a8679bbd5001679fb9d83d5b70&source=WorkersCompCentral

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