Special Investigations Unit Investigator II
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Special Investigations Unit Investigator II
Join to apply for the Special Investigations Unit Investigator II role at IEHP
Special Investigations Unit Investigator II
1 day ago Be among the first 25 applicants
Join to apply for the Special Investigations Unit Investigator II role at IEHP
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an
authentic experience!
The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and / or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and / or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS).
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!
The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and / or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and / or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS).
Commitment to Quality : The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary.
- Hybrid schedule.
- CalPERS retirement.
- State of the art fitness center on-site.
- Medical Insurance with Dental and Vision.
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account – Health Care / Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Education & Requirements
Key Qualifications
Start your journey towards a thriving future with IEHP and apply TODAY!
Pay Range
Seniority level
Seniority level
Mid-Senior level
Employment type
Employment type
Full-time
Job function
Job function
Other, Information Technology, and Management
Industries
Hospitals and Health Care
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