PRINCIPAL SPECIAL INVESTIGATIONS UNIT (SIU) INVESTIGATOR

Job Description:

PRINCIPAL SPECIAL INVESTIGATIONS UNIT (SIU) INVESTIGATOR

Description

Metro’s mission is to provide a world-class transportation system that enhances the quality of life for all who live, work, and play within LA County.

Description

Supports Metro's Risk Claims Investigation administration as investigation leader by reviewing and analyzing claims for mitigation or claims identified to have red flags or suspicion of fraud, conducting highly complex investigations, communicating findings and recommendations to assist with claim management and mitigation, denial of fraudulent and abusive claims against Metro, and other investigation of related cases of employee misconduct. The principal investigation position is assigned to the Special Investigation Unit responsible for investigation of Risk matters relating serious accidents or incidents. The Principal Investigator's responsibilities may include but not limited to the following, claims documentation and mitigation strategies, administrative investigation and reporting, scene investigation to determine causation and/or reconstruction of accidents involving Metro vehicles and personnel.

Recruitment Timelines: Exams are projected to be scheduled for the week of May 18th, and interviews are projected to be scheduled for the week of June 1st. These dates are subject to change. We encourage you to monitor your governmentjobs.com profile and emails for the latest updates.

Examples of Duties

• Conducts regular reviews of claims, analyzes information, and makes determinations of investigation path forward
• Plans, organizes, directs, and conducts complex investigations involving suspected workers' compensation fraud and abuse, insurance fraud, public liability fraud, administrative cases, and general criminal cases involving Metro; investigations may include covertly following personnel
• Serves as the principal project leader for contract firms by overseeing, monitoring, and reviewing work during claims investigations; reviews and approves invoices for payment; and audits performance of contractors
• Audits claims files using the Red Flag Assessment Program; investigates irregular findings of claim, Red Flags, or other identifiers
• Audits aging and new claim files using department processes for over $200,000 benefit appropriation and for adherence to procedures in processing
• Conducts intensive data mining reviews of information relating to claims/cases using multiple software data analysis systems to determine appropriateness for intensive investigation and surveillance
• Reviews case files which identify serial causation and recommends corrective action to resolve problems, abuses, and deficiencies
• Writes comprehensive, organized, and professional reports of investigation or policy recommendations
• Conducts investigation reviews, approves assignments or investigation
• Presents investigative findings, both orally and in writing, for determination of the prosecutorial merits of the investigation with Division or Labor Personnel, County Counsel, for concurrence before local government, and for state level reporting as required by law
• Reviews and approves investigation case files for employee hearings or external filing and reporting of suspected fraud to the local District Attorney's Offices, State Department of Insurance, and the State of California Fraud Division's Anti-Fraud Programs; prepares witnesses for court testimony and identifies evidence or obtains useful information to provide for defense of litigation
• Works with appropriate prosecution 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
• Testifies before the Workers' Compensation Appeals Board, courts, or at other administrative hearings regarding claim investigative findings
• Prepares and assists in the preparation of narrative, graphic, and statistical reports for executive and Board presentations, and internal review
• Develops policies and procedures for approval that will reduce the incidence of claim fraud and abuse or other recommendations identified as a result of investigative work
• Develops, implements, and presents Insurance Fraud Identification Training Program to Risk Management Claims Staff and Metro management personnel
• Mentors staff in matters of ethics, investigative techniques, case preparation, case strategy, techniques of court testimony, and appropriate legal preparation; keeps staff informed of current workers' compensation laws, rules, regulations, policies, and procedures
• Stays up to date on agency's current labor contracts, non-contract employee policies and procedures, workers' compensation laws, legislative changes, and case law determinations
• Complies with Metro's bill paying standards to ensure sub-contracted investigation firms are paid in a timely manner
• Responsible for communicating and implementing 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 staff
• 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

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

• Five years of relevant experience in any of the following areas, workers' compensation investigations, administrative investigations, criminal investigations, fraud investigations, law enforcement, internal investigations, insurance fraud, risk management claims, or other similar investigations; some positions in this class may require specialized experience in area of assignment

Certifications/Licenses/Special Requirements

• Certification in investigations for any of the following workers' compensation, internal investigations, criminal investigations, and risk management
• 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

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.
The following are the preferred qualifications:

• Experience leading staff specializing in claims analysis, investigation of general liability, torts, property casualty, workers’ compensation, insurance fraud, social media data mining, and related areas
• Experience conducting advanced investigations or reconstruction involving bus, rail, or auto collisions
• Experience identifying and reporting insurance fraud and Red Flags, including coordination with state or local law enforcement and prosecution offices

Essential Knowledge

Knowledge of:

• 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, workers' compensation, and criminal investigations involving Metro employees, officers, vendors, or contractors
• Specialized investigative techniques and interrogation methods
• Theories and principles and practices of human resources
• State and local traffic laws, ordinances, and regulations involved in vehicle operations
• Research and report preparation methods
• Basic money and time concepts
• Effective training techniques
• Microsoft Excel, Word, and PowerPoint

Skill in:

• Conducting complex criminal investigations
• Performing statistical analysis
• Analyzing situations, identifying problems, and recommending solutions
• Exercising sound judgment and creativity in making decisions
• Preparing comprehensive reports and correspondence
• Communicating effectively orally and in writing
• Interacting professionally with various levels of Metro and outside representatives

Ability to:

• Monitor and audit the work performance of external contractors
• Meet time constraints and deadlines
• Think and act independently
• Compile and analyze complex data
• Handle highly confidential information
• Prepare and present training programs
• Understand, interpret, and apply laws, rules, regulations, policies, procedures, contracts, budgets, and labor/management agreements
• Represent Metro before the public
• Oversee, train, and motivate assigned staff
• Drive a vehicle
• Travel to offsite locations
• Read, write, speak, and understand English

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
• Communicating through speech in the English language required
• Walking (distance 5' to 100')
• Good distance vision and/or depth perception to judge distances

AW

Metro is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, ancestry, national origin, gender, marital status, sexual orientation, religion, age, veteran status, or disability. Learn more about Metro’s Equal Employment Opportunity Program . Metro does not deny participation in the application process to anyone with prior justice system involvement, in line with Fair Chance hiring practices.

Selection Procedure

Applicants who best meet job-related qualifications will be invited to participate in the examination process that may consist of any combination of written, performance, or oral appraisal to further evaluate job-related experience, knowledge, skills and abilities.

Application Procedure

To apply, visit Metro's website at www.metro.net and complete an online Employment Application.

Computers are available to complete online Employment Applications at the following Metro location:

METRO Headquarters, Employment Office
One Gateway Plaza
Los Angeles, CA 90012

Telephone: (213) 922-6217 or persons with hearing or speech impairments can use California Relay Service 711 to contact Metro.

All completed online Employment Applications must be received by 5:00 p.m. on the closing date. Late applications will not be considered.

*Open to the public and all Metro employees

This job bulletin is not to be construed as an exhaustive list of duties, responsibilities, or requirements. Employees may be required to perform other related job duties.

*Please refer to the applicable benefit type (Regular or Temporary)*

BENEFITS FOR REGULAR EMPLOYEES

Benefits cover probationary or regular full-time (working at least 40 hrs/week) employees of Metro.

We offer a range of high-quality medical, dental and vision plan options as well as health care spending accounts for you and your family. Metro will cover a significant portion of your health care premiums.

Medical/Dental/Vision Plan- Employee has the choice of 3 separate medical plans and 3 dental plans. A separate vision plan is included in each medical plan.

Group Life Insurance- PTSC pays for an amount equal to your annual salary, rounded up to the nearest $1,000. Minimum amount of life insurance is $30,000.

Accidental Death & Dismemberment Insurance- PTSC provides $50,000 coverage for each employee. Additional voluntary coverage in amounts up to $500,000 is available at favorable premium rates.

Long-Term Disability Insurance- 100% employer paid. Provides employees with a minimum income of 60% of earnings after six months of disability. Buy up or buy down options available.

Holidays- 12 days a year: New Year's Day, Martin Luther King, Jr. Day, Presidents' Day, Memorial Day, Independence Day, Labor Day, Veterans' Day, Cesar E Chavez, Juneteenth,Thanksgiving Day, Day After Thanksgiving, and Christmas Day.

Time off with Pay (TOWP)- Compensates employees who are on approved absence from work for reasons such as illness, injury, medical and dental appointments, personal business, vacation, or observance of (a) religious holiday.
Years of Service Annual Accrual
Hire date - 5 years20 days
Beginning of 6th - 10th year25 days
Beginning of 11th - 15th year30 days
Beginning of 16th + years35 days

Pension Plan- PTSC retirement plan is the Public Employees' Retirement System (PERS). Vesting is five (5) years. Minimum retirement age is 52, based on the 2% at 62 formula.

Other Benefits: Transportation passes for employees and/or eligible dependents; Medicare; Tuition reimbursement; credit union membership; SDI; Deferred Compensation Plan; 401(K) Thrift plan; EAP; Medical and Dependent Care Flexible Spending Accounts; Flexible work schedules; and Jury Duty Pay.

BENEFITS FOR TEMPORARY EMPLOYEES

Temporary (Contingent) employees are eligible for the following benefits only:

• Kaiser medical insurance
• Public Pension Plan
• 457/401K Plan
• Flex Spending
• Paid Sick Time
• Fare Media
• Rideshare Subsidies
• Metro One Fitness membership

For more information on the Benefits Enrollment for Contingent Employees, please visit LA Metro’s Pension & Benefits website at www.benefits.metro.net .

Closing Date/Time: 5/9/2025 5:00 PM Pacific

Salary:

$82,867.20 - $124,280.00 Annually