Job Description

Job Description and Duties

The Office of Enforcement (Enforcement) at the Department of Managed Health Care handles the litigation needs of the Department, representing the Department in actions to enforce the managed health care laws. Enforcement has an exciting opportunity for an experienced, motivated, committed special investigator. The successful candidate will be responsible for conducting complex investigations and preparing accurate reports for the Department related to health care service plans pursuant to the Knox-Keene Health Care Service Plan Act of 1975, (Health and Safety Code section 1340, et seq.) and its implementing regulations (California Code of Regulations, title 28, division 1, chapter 1 (sections 1300.41-1300.826)). 

ESSENTIAL FUNCTIONS OF THIS POSITION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING (other duties may be assigned): 

Under the supervision of the Supervising Special Investigator I (SSI I), the incumbent is assigned to the Division of Investigation (DOI) in a non-Peace Officer, journey-level position. The Special Investigator conducts diverse administrative and civil investigations as part of the Enforcement's prosecution of violations of the Knox-Keene Health Care Service Plan Act of 1975 and its implementing regulations. The incumbent will work independently or in conjunction with other Special Investigators in executing thorough investigations of alleged violations. The incumbent provides complete investigative evidence to Enforcement's attorneys, Deputy Director and SSI I.

Please let us know how you heard about this position by taking a brief survey: .

Leave Program (PLP) 2025 agreement:

Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction.

You will find additional information about the job in the .

Working Conditions

The DMHC has locations in Downtown Sacramento and Rancho Cordova. Both locations are located close to light-rail with various amenities. The incumbent will work in a climate-controlled cubicle and/or office environment with artificial lighting.

This position may be eligible for hybrid telework. The telework schedule is permitted at the operational needs of the Department and is subject to change, consistent with the State Telework Policy and the DMHC’s Telework Policy. All employees who telework are required to be California residents and maintain California residency in accordance with Government Code 14200.

Special Requirements

• The position(s) require(s) a Background Investigation be cleared prior to being hired.

All applicants not currently employed by the DMHC will be subject to a pre-employment background investigation. The investigation will consist of fingerprinting and an inquiry to the California Department of Justice to disclose criminal records.

Any documents you submit for a job vacancy such as your State application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents include, but is not limited to, your Social Security Number (SSN), birthday, driver’s license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver’s license number will automatically be redacted upon submission.

Possession of Minimum Qualifications will be verified prior to interview and/or appointment .  If you are using education to meet the minimum qualifications for this position, you MUST submit a copy of your college transcripts.  Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

• Demonstrated ability to conduct complex investigations to detect violations, which includes the ability to conduct consumer outreach and interview related parties. 

• Experience collecting and analyzing evidence to support administrative actions and/or prosecution in a California Superior Court. 

• Experience conducting investigative research and reviewing healthcare related documents. Examples include, but are not limited to, financial statements, process and procedural documents, anti-fraud reports, and claim/billing-related documents.

• Experience preparing correspondence and clear/concise reports related to investigatory work. Examples include, but are not limited to, investigation referrals, interview memorandums, background reports and witness statements. 

• Demonstrated ability to act quickly, make decisions under strict deadlines and/or high pressure situations, as well as apply advanced analytical and communication skills, both verbal and written. 

• Experience maintaining effective working relationships with colleagues, program staff and management, as well as staff of other state and federal agencies, while working both independently and as part of a team.

Benefits

For information on benefits, please visit the Benefit Summary page on the CalHR website .

Additional Application Instructions

To be considered for this vacancy, please complete all applicable fields on the application form, including a list or description of previous/current occupational experience in the duties performed section.

Electronic applications through your CalCareer account are highly recommended.

Do NOT include your social security number on any submitted documents. If submitting your application via postal mail or in person, please notate RPA: 25-113 and Job Control: JC-497740 on your application.

All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to clearly demonstrate how you meet the Minimum Qualifications for the position on your State Application (STD Form 678). The application should also clearly demonstrate the candidate’s ability to meet the Desirable Qualifications identified in this job advertisement. The Classification Specification for Special Investigator  is located at the top of this Job Announcement Posting under Minimum Requirements.

Foreign Degrees or Transcripts – Applicants with foreign degrees or transcripts who wish to apply that coursework toward meeting the minimum qualifications of the classification must provide a transcript evaluation that indicates the number of units to which his/her foreign coursework is equivalent. DMHC accepts foreign transcript evaluations that are completed by one of the agencies approved by the .

PLEASE NOTE: If you are mailing your application, it must be postmarked by the final filing date. Hand delivered applications must be submitted no later than 5:00 p.m. on the final filing date. Applications slipped under the door at the Human Resources Office will be time stamped the following business day.

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is optional. It may be included, but is not required.
• Statement of Qualifications - See section below labeled "Statement of Qualifications Instructions" for more information. 
  Applications packages received without a statement of qualifications answering the questions listed, will not be considered.

Job Tags

Permanent employment, Full time, Work at office, Remote work,

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