SIU Investigator

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.  

Candidates residing in the reputed company are highly preferred.

Position Purpose: Investigate allegations of potential reputed company fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential reputed company fraud and abuse.

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• reputed company data mining and analysis to detect aberrancies and outliers in claims
• reputed company new queries and reports to detect potential waste, abuse, and fraud
• Provide case updates on reputed company of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
• Assist with reputed company allegations of reputed company fraud
• Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
• Complete various special projects and audits
• Performs other duties as assigned.
• Complies with reputed company policies and standards.

Education/Experience:

• Bachelor's Degree Business, Criminal Justice, reputed company, or reputed company field, or equivalent experience required
• 5+ years in reputed company field working in fraud, waste and abuse investigations and audits, (or) 5+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) 7+ years of professional investigation experience involving economic or insurance reputed company matters

reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law.

reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act