Mark Powers

SIU Healthcare Fraud Investigator HealthCare Support is actively seeking an SIU Healthcare Fraud Investigator to fill an opening in Los Angeles, California. Daily Responsibilities for SIU Healthcare Fraud Investigator:

• Conduct complex independent investigations resulting from the discovery of suspicious claims or incidents involving members and service providers that could potentially involve fraud, waste, or abuse.
• Reviews information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action.
• Compiles and maintains various documentation and other reporting requirements. Maintains chain of custody on all documents and follows all confidentiality and security guidelines.
• Monday to Friday 8AM - 5PM

Required Qualifications for SIU Healthcare Fraud Investigator:

• Bachelor’s degree in criminal justice or Related Field (Prefer Master’s Degree) – will consider 7 years of experience in exchange for no degree
• 3+ years in healthcare fraud investigation/detection
• Excellent research skills and the ability to support conclusions with documentary evidence.

Preferred Qualifications for SIU Healthcare Fraud Investigator:

• Managed Care experience strongly preferred
• Certified Fraud Examiner (CFE)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Professional Coder (CPC) designation by the American Academy of Professional Coders

Benefits for SIU Healthcare Fraud Investigator:

• Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (advocacy) Program

Pay Details: $43.29 to $48.39/Hour Interested in Being Considered? If you are interested in applying to this position, please click Apply Now for immediate consideration. For additional questions, you may contact us at [email protected]. Please include your phone number, Job Title, and location and our recruiters will reach out. 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.