Compliance Investigator

Description

The Compliance Investigator II has demonstrated competencies in supporting the plan-wide regulatory affairs and compliance program, including activities related to HIPAA, Fraud, Waste, and Abuse (FWA), and compliance issues. As such, conducts investigations to effectively prevent, detect, and mitigate healthcare FWA, privacy and compliance issues. Supports daily operations of the Regulatory Affairs & Compliance unit by ensuring deliverables and all case management performance metrics are met for assigned cases. This position serves as an investigative liaison between the plan and our regulatory agencies and internal departments.

Essential Duties and Responsibilities

• Proficiently performs all duties of the Compliance Investigator, independently.

• Structures and successfully completes investigations independently including writing formal investigative reports for privacy, FWA, and compliance matters. In doing so, exercises, professional judgement and escalate matters to leadership, as needed.

• Independently conducts investigative interviews, maintaining complete and accurate records.

• Prepares formal records and reports in response to enforcement agency requests to support investigations, which may include, but not be limited to the Department of Justice and Department of Medi-Cal Fraud and Elder Abuse. Demonstrates proficiency and professional acumen when interfacing with external stakeholders on behalf of the Plan.

• Works directly with DHCS Privacy Office to report privacy related incidents, provide updates upon request, ensure timely filing requirements are met for all reports and follows up on pending cases to confirm cases are closed with the DHCS Privacy Office.

• Responsible for identifying trends and linking related cases to assist with trending patterns and maintaining accurate data for daily, monthly, quarterly, and annual privacy and FWA analytics, including those fraud cases referred for recoveries.

• May provide input regarding controls for monitoring fraud-related issues within the business units.

• As directed by manger, performs quality assurance case reviews to ensure they meet DHCS requirements, regulatory, and Partnership professional standards.

• Ability to serve as regulatory affairs expert to support complex regulatory inquiries and responses to regulatory agencies.

• Encourages continuous awareness and education of unit staff, which may include development and maintenance of training materials

• Manages daily case load, prioritizing appropriately, and making recommendations to leadership to ensure the timely submission of privacy and FWA cases to DHCS

• Demonstrates proficiency in Manages the intake and ongoing maintenance of referral/inquiry platform

• Ability to assess, facilitate, and see to completion, referrals and inquiries, of varying complexity and scope, submitted to RAC

• Monitors unit tracking systems to ensure the timeliness of deliverables are met, making recommendations for improvements in tracking and/or work flows as necessary

• Competence in assessing and analyzing unit work consistent with established criteria and providing recommendations and as directed by manager, provide coaching to unit staff as needed

• Maintains awareness and understanding of regulatory requirements that govern unit responsibilities

• Makes strategic recommendation(s) to improve the accuracy, quality, and/or reporting of cases to enhance HIPAA, FWA, and compliance issues cases

• Assists Regulatory Affairs Manager with developing, maintaining, and delivering compliance training program including but not limited to:

• Updating new hire compliance trainings and annual training materials

• Making recommendations for focused department trainings based on trends and conducting targeted department trainings

• Works with departments on resolving complex regulatory required submissions

• Assists Regulatory Affairs Manager with preparing materials and presentations for PTAS and FWA Subcommittees

Skills & Qualifications

Education and Experience

• Bachelors degree in relevant field preferred or equivalent combination of education and experience;

• Minimum of two (2) years experience as a Regulatory Affairs Specialist or relevant experience in managed care with knowledge of the Medi-Cal and NCQA requirements, Medicare, and Knox-Keene.

• Experience with the investigation and reporting of HIPAA,FWA, and compliance issues related incidents.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines. Ability to work under minimal supervision and exercise independent judgment. Diplomacy and tact in handling sensitive information regarding personnel affairs as required. Ability to interact with executives and vendors effectively, handling all assignments with efficiency. Must be able to handle multiple tasks and meet deadlines. Excellent judgment.

Job Type & Location

This is a Contract position based out of Fairfield, CA.

Pay and Benefits

The pay range for this position is $43.00 - $46.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Fairfield,CA.

Application Deadline

This position is anticipated to close on Oct 7, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.