SPECIAL INVESTIGATIONS UNIT (SIU) INVESTIGATOR (RISK MANAGEMENT/INSURANCE INVESTIGATION)

This position may be responsible for, or receive training to perform, a range of pre-investigative activities related to claims investigations, including data mining and analysis related to industrial accidents and injury investigations. This role also involves reviewing cases of employee misconduct, conducting basic social media background inquiries to support claim management and risk mitigation, and assisting in identifying and addressing fraudulent or abusive claims against Metro. This position may require irregular working hours, including split shifts, weekends, holidays, 24-hour on-call assignments, and local travel, as well as potential exposure to hostile or armed criminal suspects.

Supports Metro's Risk Claims Investigation administration by reviewing and analyzing claims in the area of general liability and workers’ compensation, 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 and denial of fraudulent and abusive claims against Metro.

Recruitment Timelines: Interviews are projected to be scheduled for the week of May 25th, 2026. These dates are subject to change. We encourage you to monitor your governmentjobs.com profile and emails for the latest updates.

• Plans, organizes, and conducts preliminary investigations and case reviews and completes pre-investigation work on cases to be assigned to contract investigation firms 
• Conducts and assists in internal administrative investigations, including employee misconduct or other related cases 
• Conducts red flag assessment of injury/illness occupational claims
• Conducts intensive social media and data mining reviews and gathering of information related to claim mitigation and investigation
• Interacts with contractors when conducting and sub-contracting claims investigations
• Presents investigative findings both orally and in comprehensive professional reports for determination of the prospective merits of the case to requesting administrative section or claims department
• Represents Metro at required evidentiary hearings, medical hearings or court testimony by providing data or video evidence as necessary
• 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 claims 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
• 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

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

Preferred Qualifications

Preferred Qualifications (PQs) are used to identify relevant knowledge, skills, and abilities (KSAs) as determined by business necessity. These criteria are considered preferred qualifications and are not intended to serve as minimum requirements for the position. PQs will help support selection decisions throughout the recruitment. In addition, applicants who possess these PQs will not automatically be selected.

• Experience reviewing and processing insurance claims, including conducting or supporting claims-related investigations

• Experience conducting open-source research and utilizing various systems or tools to gather and analyze information

• Experience performing office administrative functions, including preparing documents and managing information using Microsoft Office applications (e.g., Excel and Word) at an intermediate proficiency level

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, intelligence and data 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

Special Conditions

• This job specification is not to be construed as an exhaustive list of duties, responsibilities, or requirements
• 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
• This classification is at-will and the incumbent serves at the pleasure of the hiring authority when classified as an Intermittent, Emergency, Annuitant, or Temporary employee, is assigned to the Office of Inspector General (OIG) or Board Clerk's Office, and/or reporting directly to the LACMTA Board of Directors
• Contributes to ensuring that the Equal Employment Opportunity (EEO) policies and programs of Metro are carried out

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')
• Communicating through speech in the English language required

(JZL)

Salary : $68,744 - $103,085