Healthcare Compliance Investigator
$80.06k - $106.06kIEHP
Special Investigations Unit Investigator II (Healthcare)
The SIU Investigator II is responsible for investigating and analyzing suspected cases of fraud, waste, and abuse within the healthcare environment. This role conducts comprehensive investigations, leveraging data analytics and other sources to identify unusual billing patterns and potential violations. The position ensures compliance with state and federal regulations, including CMS, HHS-OIG, DMHC, and DHCS requirements, and supports the organization’s Fraud, Waste, and Abuse (FWA) Program. Duties include reporting findings to regulatory agencies and implementing measures to prevent, detect, and correct fraudulent activities.
Education & Requirements Four (4) year s or more of relevant professional experience in health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting
Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, Claims
Bachelor's degree from an accredited institution, in lieu of the required degree, a minimum of four years additional work experience is required for the position
Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification is preferred
$80,059.20 - $106,059.20 USD Annually Hybrid Schedule, Monday & Friday are work from home days, Tuesday - Thursday onsite in Rancho Cucamonga, CA.
Medical Insurance with Dental and Vision
Career and professional development
CalPERS retirement, 457(b) option with a contribution match
#J-18808-Ljbffr
- ...A healthcare organization is looking for a Special Investigations Unit Investigator II to investigate fraud and abuse in the healthcare environment. This role conducts thorough investigations leveraging data analytics, ensuring compliance with regulations, and supports...Suggested
IEHP
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FDA
Ontario, CA2 days ago - ...Aspire General Insurance in Rancho Cucamonga is looking for a Pre-SIU Adjuster who will be responsible for investigating automobile claims with a focus on fraud detection. The role involves detailed documentation of investigations, adherence to industry regulations, and...Suggested
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...Job Description Overview Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation...SuggestedWork experience placementWork at officeLocal area$21.56 - $29.11 per hour
...This position works directly with alerts and cases generated by the bank’s fraud detection systems and uses sound judgment and investigative skills to determine whether transactions are authorized or potentially fraudulent. The analyst plays a key role in identifying fraud...Work at officeShift workCitizens Business Bank
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