SIU Investigator (Healthcare)

Location: Remote-OK, with onsite audits, provider visits, drive-by activities, and interviews as required

Salary: $56,200–$101,000 per year

Company

Healthcare organization focused on connecting people with the care they need and improving healthcare access and outcomes.

What you will do

• Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, interviews, data analytics, and other investigative resources.
• Review claims, provider billing practices, enrollment information, financial records, and related documentation to identify fraud, abuse, overpayments, and compliance concerns.
• Document investigative activities, findings, recommendations, and outcomes, and prepare case summaries, referrals, and supporting reports.
• Collaborate with compliance, legal, provider and payment integrity teams, regulatory agencies, law enforcement entities, and other stakeholders.
• Support audits, overpayment identification and recovery, regulatory responses, corrective actions, and other program integrity initiatives.
• Monitor emerging fraud schemes and billing irregularities and recommend cases for further review.

Requirements

• Bachelor's degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field, or equivalent experience.
• At least 2 years of experience in fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related field.
• Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records is preferred.
• Ability to comply with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies.

Nice to have

• Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or another related investigative, auditing, or compliance certification.

Culture & Benefits

• Remote, hybrid, field, and office work schedules are supported depending on role requirements.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and paid holidays.
• Equal opportunity workplace committed to diversity and inclusion.
• Qualified applicants with arrest or conviction records are considered in accordance with applicable California and Los Angeles County requirements.