Senior Fraud, Waste and Abuse (FWA) Investigator
$65.3k - $111kPacificSource
- # Senior Fraud, Waste and Abuse (FWA) InvestigatorApplylocations: Portland, ORtime type: Full timeposted on: Posted Todayjob requisition id: 2026-865# **Looking for a way to make an impact and help people?***Join PacificSource and help our members access quality, affordable care!***PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.** PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.The Senior Fraud, Waste and Abuse Investigator manages work related to fraud, waste and abuse audits and investigations across several independent and specialized teams. Functions include, conducting in depth investigations making decisions and recommendations on case direction, scope and timing; collaborating with managers and staff in Claims, Provider Network, Appeals and Grievances, Finance, Utilization Management and Analytics throughout the audit lifecycle; ensuring audit compliance with state and federal laws and regulations, contract requirements and company policies and procedures as they pertain to fraud, waste and abuse.**Essential Responsibilities:*** Independently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims,* Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures.* Proactively utilize available analytic resources to identify patterns of potential Fraud, Waste and Abuse, initiating audits when necessary.* Conduct fact-finding interviews with internal staff, external providers, patients and other relevant parties regarding medical and behavioral health services initiating investigations when necessary.* Utilize available Open Source Intelligence (OSINT) tools to verify provider licenses, research criminal history, disciplinary actions, financial assets and liabilities.* Attend and participate in regional FWA Task Force and other state or federal meetings.* Establish and maintain a comprehensive knowledge and understanding of current state and federal reporting requirements ensuring FWA reporting is received, summarized, catalogued, and disseminated to the appropriate agencies.* Ensure regulatory reporting is developed, accurate, and submitted timely.* Serve as an internal Subject Matter Expert (SME) on matters related to auditing and FWA.* Develop and conduct internal FWA related training.* Collaborate with government agencies during audits, investigations and Requests for Information (RFI).* Present and discuss case findings and recommendations in case review meetings with department and company management.* Participate in the development and presentation of FWA reporting for the Corporate Compliance Committee and the Audit and Compliance Committee of the Board.* Coordinate and manage the production of investigative materials in support of, settlement negotiations.**Supporting Responsibilities:*** Meet department and company performance and attendance expectations.* Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.* Perform other duties as assigned.**SUCCESS PROFILE****Work Experience:** Minimum of 5 years of experience with complex healthcare fraud investigations required. Experience facilitating audit activities across specialized teams required. Experience navigating case management, claims and OSINT platforms preferred.**Education, Certificates, Licenses:** Bachelor’s degree in business administration, criminal justice, or related field required. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Ability to obtain Certified Fraud Examiner (CFE) or equivalent certification within 24 months of employment required.**Knowledge:** Strong working knowledge of investigative techniques and procedures as they relate to health care fraud, waste and abuse is required. Ability to gain a thorough understanding of PacificSource compliance initiatives. Respond timely to regulatory inquiries. Maintain sufficient reference materials to adequately research compliance issues. Ability to organize large complex investigative audits that involve working with multi-functional teams under strict deadlines. Ability to communicate effectively with all levels of the organization, federal and state agencies, providers, and members, both verbally and in writing. Working knowledge of legal and medical terminology. Ability to read, interpret, and apply the complex language and ideas found in provider contracts, case law, criminal and civil statues. Ability to work under time pressures, and remain professional in emotionally charged situations. Computer proficiency in a Windows environment, including Microsoft Office Suite.**Competencies**AdaptabilityBuilding Customer LoyaltyBuilding Strategic Work RelationshipsBuilding TrustContinuous ImprovementContributing to Team SuccessPlanning and OrganizingWork Standards**Environment:** Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.**Skills:**Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork**Compensation Disclaimer**The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.**Base Range:**$65,296.83 - $111,004.62# **Our Values**We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:* We are committed to doing the right thing.* We are one team working toward a common goal.* We are each responsible for customer service.* We practice open communication at all levels of the company to foster individual, team and company growth.* We actively participate in efforts to improve our many communities-internally and externally.* We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.* We encourage creativity, innovation, and the pursuit of excellence.**Physical Requirements:** Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.**Disclaimer:** This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
- J-18808-Ljbffr PacificSource
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Senior Fraud, Waste and Abuse (FWA) Investigator in Portland, OR vacancy
$65.3k - $111k
...develop and utilize each person’s talents and strengths.The Senior Fraud, Waste and Abuse (FWA) Specialist serves as the organization’s subject matter... ...the organization's ability to detect, prevent, investigate, recover, and report fraud, waste, abuse, and payment integrity...SeniorFraudWork experience placementWork at office- PacificSource is seeking a Senior Fraud, Waste and Abuse Investigator in Portland, OR to lead complex FWA investigations and audits. You will plan, conduct, and document onsite and desktop investigations of health care claims, and present findings to management. The role...SeniorFraud
- PacificSource is seeking a Senior Fraud, Waste and Abuse (FWA) Specialist to lead and advance our Payment Integrity and FWA programs. You will serve as a subject matter expert, develop policies, coordinate audits, and report findings to leadership and regulatory bodies...SeniorFraudFull time
- Banner Bank is seeking a Fraud Investigator to protect customers and the organization by identifying and investigating potential fraud. The role requires a curious, detail-oriented individual who can research data sources, review transactions, and conduct investigations...SeniorFraud
$88.66k - $104.3k
A leading financial institution is seeking a Fraud Analyst to develop fraud-related reporting and analyze transactional data to identify trends. The ideal candidate will have a bachelor's degree and at least four years of experience in risk management or audit. You will...SeniorFraud- ...68Position Type:EmployeePosition Title:*Investigator 3 - Civil Enforcement Division (Portland... ...this position will do the same.Health care fraud enforcement is a national priority. The... ...Medicaid providers and allegations of abuse/neglect and financial exploitation of residents...FraudPermanent employmentFull timeLocal area
- The SIU Investigator role at Cambia Health Solutions focuses on fraud and abuse investigations, audits and education. You will analyze data, interview subjects, and coordinate with CMS, HHS-OIG and law enforcement as needed to recover misused funds and prevent future incidents...Fraud
$57.8k - $78.2k
...We Are Looking For Every day, Cambia’s dedicated team of SIU Investigators are living our mission to make health care easier and lives... ...SIU Investigator conducts investigations into allegations of fraud and abuse. Responsibilities include performing thorough review of...FraudWork at officeLocal areaImmediate startWork from homeRelocationFlexible hours3 days per weekCambia Health Solutions
Vancouver, WA15 hours ago- Multnomah County's Department of County Human Services seeks a Human Services Investigator to conduct abuse/neglect investigations for adults with developmental disabilities and write comprehensive reports within a 55-day timeframe. The role requires thorough reviews of...
- ...'s marketplace at scale? We're seeking a Senior Program Manager who will drive our brand... ...and engineering teams to translate complex abuse patterns into engineering-ready... ...Deep understanding of brand protection, fraud detection, abuse prevention, or trust and...SeniorFraudNight shift
$45.27 - $55.67 per hour
...policy statements on legislative topics. Provide Senior Management analysis and assessment of how... ...programs negotiating Corrective Action plans. Investigations Conduct investigations of code of conduct, fraud, waste and abuse allegations. Review mental health treatment...SeniorFraudHourly payFull timeContract workTemporary workPart timeFor contractorsWork experience placementWork at officeRemote workWork from homeFlexible hours- ...Senior Counsel, Toxic Tort and Product Liability Defense About the Company Respected law firm Industry Legal Services... ...toxic tort, asbestos, general liability, employment, bad faith/fraud, or insurance defense. While trial experience is a plus, it is not...SeniorFraud
Confidential
Portland, OR2 days ago $30.34 - $35.69 per hour
...In this role you'll Research data sources and review financial transactions to support fraud investigations. Conduct low to high complexity fraud investigations using a mix of automated and manual methods. Identify potential fraud risks and escalatate concerns following...FraudBanner Corp
Lake Oswego, OR1 day ago$30.34 - $35.69 per hour
...Overview As a Fraud Investigator, you will play a pivotal role in protecting our customers and organization by identifying and investigating potential fraud. This role requires a naturally curious, detail-oriented individual motivated to make a real impact. Company: Banner...FraudBanner Bank
Lake Oswego, OR2 days ago- A leading medical management firm is searching for an Experienced Field Investigator in Portland, Oregon. The candidate will engage in surveillance and investigative activities to detect potential fraudulent insurance claims. This involves performing covert surveillance...SeniorFraudWeekend work
- The Oregon Department of Justice’s Civil Enforcement Division seeks a Referral Investigator (Investigator 3) in Portland to join a dynamic team investigating health care fraud statewide. The position offers a hybrid work schedule and opportunities to handle complex cases...Fraud
- ...Department of Justice, Civil Enforcement Division, invites applicants for the Investigator III (Referral Investigator) position in Portland. Hybrid work is offered. The role emphasizes health care fraud enforcement, reviewing medical and Medicaid records, interviewing...Fraud
- CACI International Inc. is pursuing an Experienced Background Investigator for the West Region. This remote role supports investigators across states, with Idaho Falls, ID and Portland, OR as example locations. You will conduct standard background checks, verify credentials...SeniorRemote jobFlexible hours
$121.7k - $152.1k
We're looking to hire a Fraud Investigator to join our Account Fraud team, with a focus on Account Takeover (ATO) and other forms of third party... ...and in writing, to audiences ranging from customers to senior leadership Have a track record of identifying operational inefficiencies...Fraud- Cumberland County Government seeks a Lead Investigator for the SAKI grant-funded work within the District Attorney’s Office. This role conducts kit inventories, manages case investigations, and collaborates across agencies to meet grant objectives. A training period on...SeniorFull timeWork at office
- ABOUT US Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for...FraudLocal areaNight shiftWeekend work
$70k - $80k
...range $70,000.00/yr - $80,000.00/yr Legal Investigator What We’re Looking For: Our Portland... ...other characteristic protected by law. Seniority level Seniority level Entry level Employment... ...Investigator (SI) - Insurance Fraud Investigation/Field Mobility Corrections...FraudFull timeTemporary workWork at officeNight shift- ...professionals dedicated to protecting Nike’s value and brand. The Senior Auditor will report directly to the GARM Director and support... ...Operations, Supply Chain, Finance and Accounting, Human Resources, Fraud, LegalDemonstrated data analytics capabilitiesUnderstanding of...SeniorFraudFull time
- Mercury is recruiting a Fraud Investigator to join the Account Fraud team, focusing on Account Takeover (ATO) and third-party fraud. You will investigate suspected compromises, respond to high-risk security incidents, and serve as a primary contact for customers during...Fraud
- Affirm is seeking an experienced Model Risk Management professional to lead validation of complex credit and fraud models. You will build automated Python-based monitoring, track KPI drift, and work with model developers to remediate issues while coordinating with Audit...SeniorFraud
$200.7k - $250.9k
Mercury is seeking a Senior Risk Strategist to focus on card fraud strategies in a hybrid work environment. This role requires 6+ years of analytical experience, with a strong emphasis on card fraud detection and compliance. You will partner with various teams to implement...SeniorFraudRemote job$125k - $160k
...approach challenges with a spirit of innovation . HowYou’llMake an Impact We are seeking a full-time Archaeologist V (senior archaeologist/ principal investigator) for our Portland or Seattle office. Qualified candidates interested in working remotely from other parts of the...SeniorFull timeWork at officeLocal areaRemote work$91k - $140k
...and facilitate blameless postmortems to investigate root causes and implement learnings.... ...Decision Management Program (DMP) team as a Senior Software Development Engineer at our Vancouver... ...products and play a crucial role in fraud prevention across our services. We offer...SeniorFraudFull timeWork at officeMastercard
Vancouver, WAmore than 2 months ago$74.93k - $153k
...ends on May 31, 2027.Work you’ll do As an Unclaimed Property Tax Senior in the Indirect Tax group you will be a valuable member on tax... ...not CPA eligible:Licensed attorneyEnrolled AgentCFE (Certified Fraud Examiner)PreferredAdvanced degree such as Masters of Tax, JD and...SeniorFraudWork at officeLocal area- ...an Engineer with a strong background in environmental and solid waste treatment to lead engineering and construction at landfills and related facilities. The role requires direct collaboration with senior management, mentoring of junior staff, and ongoing management of...Senior
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Fraud, Waste and Abuse (FWA) Investigator. Be the first to apply!
Related searches
- defense investigator Portland, OR
- compliance investigator Portland, OR
- background investigator Portland, OR
- credit investigator Portland, OR
- human rights investigator Portland, OR
- aml investigator Portland, OR
- corporate security investigator Portland, OR
- insurance investigator Portland, OR
- forensic investigator Portland, OR
- security investigator Portland, OR