The primary focus of this job is to be responsible for the initial development of information via computer that would be used in the furtherance of investigations pertaining to injured workers, medical providers, agents, or employers. This position is responsible for developing actionable intelligence that is timely and relevant, identifies trends, and is comfortable in providing statistical analysis as needed. This position completes the preliminary background investigations that support the Regional Investigators and Specialists.
This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.
A. EDUCATION REQUIRED:
Associates degree in criminal justice, law enforcement, insurance, statistics, or a related field. Combination of related education and experience may be considered in lieu of degree.
B. EXPERIENCE REQUIRED:
Minimum three (3) years of workers compensation experience, including demonstrated technical knowledge in insurance operations (i.e. applying relevant workers compensation laws, regulations, guidelines, and/or policies that would impact claims and/or underwriting activities) required.
• Supports the Regional Investigators, Specialists and Vendors by completing a comprehensive review of internal/external sources, including but not limited to researching vital information, developing detailed investigative reports to prepare assignments for Regional Investigators, and evaluating and reporting of unusual investigative findings that may provide opportunity for field investigation leads.
• Quantify and identify historical trends, effectively manage work-loads, and communicate
opportunities that could impact results.
• Prepare and analyze historical trends, profile charts, and flow charts associated with
databases to display relationships of information.
• Summarize technical, legal, and/or financial information into a report.
• Conduct investigations while establishing and maintaining professional, working
relationships with the insured, claimants, witnesses, attorneys, and criminal justice
• Conduct telephonic research and/or interviews (i.e. recorded as needed).
• Review and document social media sources as part of the investigation process.
• Supports the tactical analysis relating to the initiation, development, and completion of
• Organizes, processes, and replies to inquiries in a timely manner.
• Prepares detailed/timely reports that are comprehensive and are compliant with
documented due dates.
• Serves as a resource to the Claims Investigation Coordinator.
C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
• Technical knowledge regarding claim data analysis techniques and analytical software including Excel and Business Objects.
• Knowledge of computers and word processing software with the ability to prepare reports.
• Basic knowledge of spreadsheet software and access databases.
• Ability to perform basic mathematic calculations to determine mileage, timelines, hour calculations, determining values for claims exposures or calculating losses for reporting of questionable claims.
• Basic knowledge of the criminal justice system including the rules of evidence.
• Basic knowledge of sources of information including court and other public records, computer databases, and state, local and federal offices.
• Excellent analytical skills.
• Excellent oral and written communication skills.
• Knowledge of applicable workers compensation state and federal laws, statutes and regulations.
• Basic knowledge of legal and medical terminology.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation and format.
• Ability to work independently and handle multiple changing priorities.
• High degree of integrity and confidentiality.
• Ability to type 40 wpm.
D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:
• Progress towards or completion of American Education Institute (AEI) designations (i.e. SCLA, FCLA, LPCS,).
• Knowledge of the Michigan Workers Disability Compensation Act and other relevant civil and criminal laws.
• Progress towards or completion of Investigative designations (i.e. IASIU, NICB, CIFA).
Work is performed in an office setting with no unusual hazards. Minimal travel required.
REQUIRED TESTING: (For HR use only)
Basic Excel, Intermediate Windows, Intermediate Word, Basic Access, Reading Comprehension, Proofreading, Math, Typing 40 wpm
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