Special Investigations (Healthcare) Investigator II
IEHP, Rancho Cucamonga, CA, United States
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
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