Fraud Investigator, Department of Insurance Series

California State Personnel Board Specification

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Series established April 13, 1990

Scope​​​

This series specification describes the two Fraud Investigator classes used by the Fraud Division, Department of Insurance, Criminal Investigations Branch. These classes are used for positions that supervise and manage felony criminal investigations of insurance fraud and related State and Federal criminal codes. Subordinates perform a full range of peace officer duties and responsibilities in the accomplishment of their assignments in accordance with the California Penal Code, Section 830.3; interrogate suspects and interview witnesses; take statements and make arrests; provide technical assistance and training to law enforcement and insurance industry personnel; provide fraud detection and awareness training to law enforcement, insurance industry personnel, and the general public; testify as expert witnesses for prosecutors at preliminary hearings and criminal trials in State and Federal courts; collect, organize, and analyze business records, including, but not limited to, bank records, law enforcement records, medical records, and accounting records related to complex white-collar crime cases; work with local, State, and Federal peace officers conducting complex investigations; work with informants and utilize sophisticated surveillance and electronic evidence-gathering equipment; gather intelligence data; provide witness protection as directed by local and Federal prosecutors; and perform special assignments such as a range master, defensive tactics instructor, and computer forensic expert.​

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Definition of ​​Series

The Department of Insurance, Criminal Investigations Branch, Fraud Investigators supervise and manage complex criminal investigations of insurance fraud and white-collar crime as defined by the California Insurance and Penal Codes pertaining to: organized criminal activity of staged auto investigations including, but not limited to, swoop and squat, paper collisions, vehicle theft, vehicle arson, and false or inflated damage claims; medical and health claims, including, but not limited to, fraudulent medical claims, inflated billings, disability insurance fraud, dental and pharmacy false claims; fraudulent life insurance claims, and murder-for-hire cases; workers' compensation fraud including, but not limited to, claimant fraud, premium fraud, and illegal mill operations involving legal and medical providers; arson investigations including, but not limited to, commercial and residential arson claims, and arson for hire; and property fraud including, but not limited to, residential and commercial burglaries, and watercraft arson and theft.

Factors Affecting Position A​llocation

Complexity and variety of investigations, independence of action and decision making, and degree of supervision exercised and received.

Definition of L​​​evels

Supervising Fraud Investigator I, De​​partment of Insurance

This is the working supervisory level of the series. Under the direction of a Supervising Fraud Investigator II, incumbents are given the full range of supervisory duties for a team of Investigators and officers from other law enforcement agencies in task force environments; review criminal investigation work products of subordinate staff; assign the tasks of training subordinate staff, allied law enforcement, and insurance industry personnel; and conduct background and/or internal affairs investigations, analyze case referrals, and perform special investigative projects as designated by the regional Supervising Fraud Investigator II, Department of Insurance, or Fraud Division management.

Incumbents at this level work closely with local law enforcement agencies to coordinate their respective investigative efforts on given cases and to provide technical advice and training; plan and coordinate complex fraud investigations involving multiple service of search warrants, felony arrest warrants, and undercover operations; provide training and technical assistance to local, State, and Federal law enforcement officers; provide insurance fraud awareness, detection, and reporting requirement training to law enforcement personnel, insurance industry personnel, and the general public; testify as expert witnesses for prosecutors in State and Federal courts; analyze case referrals to determine if criminal investigations are warranted; conduct administrative assignments; monitor case investigation activities utilizing various computer software packages and databases; develop investigative plans with subordinate staff to ensure timelines are met; prepare press releases; coordinate with allied agencies joint case and task force operations; supervise field operations to enhance operational efficiency and ensure officer public safety; supervise formal Fraud Division firearm and weaponless defense proficiency training; and manage informant compensation and/or security.

Supervising Fraud Investigator II, Departmen​t of Insurance

This is the full supervisory level in this series. Under the direction of the Bureau Chief, Criminal Investigations Branch, Fraud Division, incumbents function as the manager responsible for planning, organizing, and directing the law enforcement staff and programs in a designated geographical area of the State; manage the regional office budget; oversee the implementation of the training program for local law enforcement agencies and insurance company personnel in their region; prepare and facilitate a formal public outreach program to provide training in insurance fraud awareness, detection, and reporting requirements; assist in the administration of a specialized investigative program or project as mandated by law or required by Division administration; act as liaison when representing the Department, Branch, or Division before allied law enforcement, State and Federal prosecutors, and insurance industry groups; appear as a speaker before law enforcement, and public and insurance industry groups; direct and control on-scene media events; coordinate Grant Funded task force operations with prosecutors and allied law enforcement; prepare and implement Branch and Division policy and procedures; review and analyze regional area crime trends; identify and develop formal in-house training programs to meet Branch and Division needs; manage and assist in the development of various Division budgets; testify at criminal, legislative, and administrative proceedings as an expert witness; and prepare, analyze, and monitor legislation affecting the Branch and Division.

Minimum Qualif​ications

All Levels​​

Applicants may be admitted into the examination without meeting all of the requirements in this section, but the applicant must meet those requirements prior to appointment.

Must meet the peace officer selection standards developed by the Commission on Peace Officer Standards and Training per Penal Code section 13510(a) and in accordance with existing law; and

Firearm Conviction Disqualification: Anyone who is restricted for employment-related purposes from accessing, possessing, carrying, receiving, or having under their control a firearm or ammunition under all applicable State or Federal laws is ineligible for appointment to any position in these classifications; and

Supervising Fraud Investigator I​​​​​, Department of Insurance

Either I​

Experience: One year of experience in the California state service performing the duties of an Investigator, Range B.

Or II​​

Experience: Three years of experience in an investigative assignment performing criminal investigations (as a Peace Officer as defined by the California Penal Code, Chapter 4.5, Sections 830.1, 830.2, 830.3, and 830.8) in a government agency, one year of which must have been at a level comparable to the classification of Investigator, Range B. and

Education: Equivalent to completion of two years of college (60 semester units) with a major in law enforcement, criminal justice, administration of justice, police science, or criminology, and possession of, or eligibility for, the Peace Officer's Standards and Training Specialized Supervisory Certificate within 24 months of appointment. Additional experience may be substituted for the required education on a year-for-year basis. (Applicants who are being considered for positions assigned as "Peace Officer" status, as defined by California law, must possess the educational equivalent of completion of the 12th grade.)

Supervising Fraud Investigato​r II, Department of Insurance

Either I​​

​Experience: One year of experience performing investigative duties in the California state service performing the duties of a Supervising Fraud Investigator I, Department of Insurance.

Or II​

Experience: Four years of increasingly responsible experience as a peace officer as defined in Sections 830.1, 830.2, 830.3, or 830.8 of the California Penal Code, Chapter 4.5, in an investigative assignment performing criminal investigations, at least two years of which must have been in a supervisory capacity. (Experience in the California state service applied toward this requirement must include at least two years performing the duties comparable to the classification of Supervising Fraud Investigator I, Department of Insurance.) and

Education: Equivalent to completion of two years of college (60 semester units) with a major in law enforcement, criminal justice, administration of justice, police science, or criminology, and possession of, or eligibility for, the Peace Officers Standards and Training Specialized Supervisory Certificate within 24 months of appointment. (Applicants who are being considered for positions assigned as "Peace Officer status, as defined by California law, must possess the educational equivalent of completion of the 12th grade.)

Knowledge and Abilit​​ies

Supervising Fraud Investiga​​tor I, Department of Insurance

Knowledge of: Criminal investigative techniques and procedures; rules of evidence and court procedures; laws of arrest, search and seizure, including seizure of computers; proper tactics and use of force in making arrest, felony car stops, and high risk entries; service of legal process and the legal rights of citizens; interview and interrogation techniques; provisions of the California Penal Code, Insurance Code, Evidence Code, Business and Professions Code, Health and Safety Code, and related Federal statutes; techniques for securing, preserving, and handling evidence; the use and capabilities of the California Law Enforcement Telecommunications System (CLETS) and the Fraud Integrated Data Base (FIDB); sources of information in locating witnesses and suspects; general training techniques and methods as applied to peace officer training; undercover operations utilizing informants; procedures for operating specialized surveillance equipment; computer applications and software utilized by the Fraud Division; Department and Branch policies and procedures; application of principles and techniques of personnel management and supervision; advanced training techniques and methods as applied to police officer training; Department's Equal Employment Opportunity Program objectives; and a supervisor's role in the Equal Employment Opportunity Program and the processes available to meet equal employment opportunity objectives; communication and active listening skills; behaviors indicative of potential hostility; techniques for effective interaction with diverse communities; how to approach problems with cultural awareness and sensitivity; cultural differences and similarities; implicit and explicit biases; community engagement and strategies and the benefits of effective community engagement; reporting obligations when biased behavior or misconduct is observed; characteristics protected under the Racial and Identity Profiling Act.

Ability to: Plan and conduct complex investigations into insurance fraud and white-collar crime; apply laws and rules of evidence to specific situations; gather and analyze facts and evidence; write clear and concise reports of case investigation for State and Federal prosecutors; analyze situations accurately and take effective action; conduct interviews of witnesses and interrogate suspects; effectively participate in, or direct, undercover operations and surveillance assignments operations; establish and maintain effective working relationships and be able to speak effectively before groups; adapt quickly to changing situations; photograph crime scenes and use sophisticated evidence gathering equipment; properly prepare and execute search warrants including, but not limited to, the search and seizure of computer equipment; make felony arrests using proper tactics; appear and testify as an expert witness in State and Federal courts; file criminal complaints in State and Federal courts; use, maintain, and qualify with Division approved firearms, and maintain firearms, and maintain firearm proficiency as required by POST and Division policy; properly utilize emergency equipped vehicles; serve legal documents; transcribe and dictate reports of surreptitious recordings; develop and control confidential informants;; operate computer applications and software utilized by the Fraud Division; participate in covert stationary, mobile, or aerial surveillances; serve as range master, defensive tactics, and computer forensic expert on special forensic assignments; assume fictitious identities for undercover roles; plan, conduct, and coordinate complex investigations as a lead agent; conduct and coordinate multiagency task force operations; provide insurance fraud awareness, detection, and training on reporting requirements to allied law enforcement insurance industry personnel, and the general public; conduct background and internal affair investigations as required; act as a Division Training Instructor or Field Training Investigator; plan and conduct the most difficult and complex criminal investigations; effectively supervise the work of a team of criminal investigators, other investigative personnel, and support staff; provide technical advice and training to law enforcement agencies and insurance industry personnel; independently supervise a special project or assignment in a region or statewide basis; competently conduct background and internal affairs investigations; provide training to allied law enforcement, insurance industry personnel, and the general public relative to fraud detection and prevention; effectively contribute to the Department's equal employment opportunity objectives and the processes available to meet equal employment opportunity objectives; be open-minded, flexible, and willing to learn and understand other cultures; social and cultural perceptiveness; seek clarifying questions to get a better understanding of the issue(s); maintain neutrality; identify effective ways to communicate and/or provide support; work cooperatively with various cultural backgrounds and others in the community; defuse, negotiate, and resolve conflicts; recognize and respect diversity through words and actions; effectively investigate allegations of misconduct pursuant to departmental policy; treat all people with respect and in an unbiased and unprejudiced manner; recruit qualified individuals who understand and demonstrate respect for diverse communities.

Supervising Fraud In​​vestigator II, Department of Insurance

Knowledge of: All of the above, and techniques and methods involved in administering specialized investigative and enforcement programs and the implementation of training programs to other law enforcement agencies; organization and functions of the Fraud Division and its relationship to other law enforcement agencies; Department's Equal Employment Opportunity Program objectives; and a supervisor's role in the Equal Employment Opportunity Program and the processes available to meet equal employment opportunity objectives.

Ability to: All of the above, and plan, organize, and manage the investigative efforts of two or more teams in a region; manage a specific program or project by region or statewide; employ sound management principles in regional procurement practices; formally present information regarding insurance fraud detection, awareness, and reporting to various groups (e.g., law enforcement personnel, insurance industry personnel, or the general public); develop and administer budgets for Division and regional offices utilizing sound fiscal management techniques; identify local insurance fraud crime trends; understand how written laws, policies, and codes relate to the Fraud Division and regional office policies and procedures; make decisions to accomplish Department, Division, or regional office goals; and effectively contribute to the Department's equal employment opportunity objectives.

Special Persona​l Characteristics

Both Leve​​ls:

Willingness to work throughout the State and at unusual hours, as required; keenness of observation; good memory for names, faces, places, and incidents; associate with criminally inclined persons and environments in performance of duties; satisfactory maintain a clean record as a law-abiding citizen; possess a valid driver license of the appropriate class issued by the Department of Motor Vehicles; work under stress and adverse conditions; perform tedious tasks (e.g., reading through large case investigation files, or working in a surveillance vehicle for long periods of time); learn about insurance fraud and related legal issues and procedures; comply with established policies and procedures of the Fraud Division; physically restrain suspects while performing the duties of a peace officer; carry out all peace officer duties; speak in front of groups; carry firearms; travel frequently; and safely operate a motor vehicle.

Special Physical C​​haracteristics

Both Levels:​

Possession and maintenance of sufficient strength, endurance and agility necessary to perform the essential functions of the job with or without reasonable accommodation; hearing, vision, and color vision sufficient to perform the essential functions of the job with or without reasonable accommodation.

Additional Desirable Ch​aracteristics

Both Levels:​

In addition to the above knowledge and abilities, possession of the appropriate certificates as evidence of increased competency at each level is desirable. Also desirable is evidence of completed course work in the following subject areas: introduction to criminal justice, introduction to criminal law, basic investigation, evidence, criminal procedure and laws of arrest, and search and seizure.

Class Histo​​ry​​​