Healthcare Fraud Investigator

Healthcare Fraud Investigator

HealthCare Support is actively seeking a Healthcare Fraud Investigator to fill an opening with a non-profit health plan that provides Medicare and Medi-Cal healthcare services to over 1.5 million members in Rancho Cucamonga, California.

Daily Responsibilities for the Healthcare Fraud Investigator:

• The Lead Investigator – Special Investigations Unit (SIU) (Lead Investigator) is responsible for investigating and resolving high complexity allegations of healthcare Fraud, Waste and Abuse (FWA) by medical professional, facilities, and members.
• This position researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. The incumbent serves as a subject matter expert for other investigators.
• Shift: Monday – Friday, 8:30 a.m. – 5:00 p.m.

Required Qualifications for the Healthcare Fraud Investigator:

• Bachelor’s degree from an accredited institution required (preferably in a related field)
• 6+ years relevant professional experience in fraud, waste, and abuse investigations, including Federal and State reporting requirements
• 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, or claims processing
• Accredited Healthcare Fraud Investigator (AHFI) certification required
• Compliance program principles and practices of managed care
• Federal and state guidelines as well as ICD, CPT, HCPCS, coding

Preferred Qualifications for the Healthcare Fraud Investigator:

• Master’s degree from an accredited institution preferred

Benefits for the Healthcare Fraud Investigator:

• Very low healthcare premiums ($35 – $100 depending on the plan!)
• 3 ½ weeks of PTO (18 days) & 11 Paid Holidays
• Fitness Reimbursement up to $125/a year and on-site fitness facility
• Tuition reimbursement after 1 year of employment
• 457(b) Retirement Plan – matches 3% of base salary
• CalPERS Retirement Plan (i.e., pension plan for all employees) – full vesting after 5 years

Pay Details: 

• $104,041.60 – $137,841.60
• Annual HEDIS Incentive: Up to 10% | They offer annual merit increases up to 5% based upon their individual performance | Relocation: They offer reimbursement depending on where the candidate is coming from (up to $7K in-state); they have more budget for out of state

Interested in being considered?
If you are interested in applying to this position, please click Apply Now

For immediate consideration or if you’d like to stand out, email a copy of your resume to Brandon.schabbel@healthcaresupport.com 

Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

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