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
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. T his 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.
Examples of Duties
- 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
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
- 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 qualificat