Healthcare Fraud Investigator Salary in California

Join Our Team as a Fraud Investigator at IHMVCU! IHMVCU is seeking a detail-oriented and proactive Fraud Investigator to join our team. As a Fraud Investigator, you will play a crucial role in safeguarding the assets and reputation of IHMVCU by detecting and preventing fraudulent activities. You will be responsible for conducting thorough investigations, analyzing data and implement fraud controls to mitigate risks and protect our members. This role is located at our beautiful headquarters located on River Drive in Moline, IL. This facility includes a comfortable office environment with an on-site gym facility. Summary of the position: The Fraud Investigator role is responsible for overseeing, monitoring and investigating all types of fraud. It's important for this role to consistently monitor fraud reports to analyze and spot trends in order to make data-driven decisions on current procedures as necessary to protect members and the Credit Union. The Fraud Investigator will conduct tho

Position: Fraud Investigator Location: Baltimore OR Owings Mills MD (Remote/ Hybrid) Job Type: 6 months Contract - Possible extension Hiring Manager Notes: This team is tasked with identification, remediation and prevention of fraud, waste and abuse resulting in savings and recovery of funds. This project is focused on BG research in enrollment fraud. Needs someone to come onboard and look through enrollment files. Remote in EST time zone OR on-site around 2 times per week in Baltimore and/or Owings Mills. Must have analytical skills, can do research, great with documentation and comm, great with MS office. Will have to do research to make sure members are who they say they are, living where they say they live, etc. Will be doing preliminary research for the actual Investigators. Preferred: Healthcare bg, compliance bg, data analytic bg, Will be one round of interview. Video conference Job Description: Job Duties: The role of the Special Investigations Unit (SIU) Investigator is to ass

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

Qualifications: •A minimum of a four-year college degree, either specifically in accounting, finance, economics, computer science with data analysis, applied statistics, or equivalent post-college work experience. •Excellent analytical, communication, and organizational skills. •The ability to function as an integral part of an investigative team and work in a group setting. •Knowledge of fundamental computer applications, such as Word, Excel, and Access. •Proficiency with presentation software, such as PowerPoint. Preferred Skills: •The ability to review financial records and advise or assist in the investigation of alleged fraud. •Designation as a Certified Fraud Examiner. •Experience with statistical sampling and/or advanced statistical training. •Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data. •A CPA is not required; but the position qualifies for CPA accreditation purposes. Duties Descrip