Special Investigations; Healthcare Investigator II

Special Investigations Unit Investigator II (Healthcare)

The SIU Investigator II is responsible for investigating and analyzing suspected cases of fraud, waste, and abuse within the healthcare environment. This role conducts comprehensive investigations, leveraging data analytics and other sources to identify unusual billing patterns and potential violations. The position ensures compliance with state and federal regulations, including CMS, HHS-OIG, DMHC, and DHCS requirements, and supports the organization’s Fraud, Waste, and Abuse (FWA) Program.

Duties include reporting findings to regulatory agencies and implementing measures to prevent, detect, and correct fraudulent activities.

• Four (4) year
  s or more of relevant professional experience in health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting
• 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
• Bachelor's degree from an accredited institution, in lieu of the required degree, a minimum of four years additional work experience is required for the position
• Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification is preferred

Hybrid Schedule, Monday & Friday are work from home days, Tuesday - Thursday onsite in Rancho Cucamonga, CA.

Medical Insurance with Dental and Vision

Career and professional development

CalPERS retirement, 457(b) option with a contribution match