Top 141 Insurance fraud investigator Jobs in California

Compliance Investigator II
Partnership HealthPlan of California —Fairfield, CA
- $96,970.04 - $121,212.56 a year
- Full-time
- Microsoft Excel
- HIPAA
- Office
Social Media Investigator
DigiStream Investigations —Fremont, CA
- From $21 an hour
- Full-time
- Background check
- Writing skills
- HIPAA
- Health savings account
- Health insurance
Social Media Investigator
DigiStream Investigations —Oakland, CA
- From $21 an hour
- Full-time
- Background check
- Writing skills
- HIPAA
- Health savings account
- Health insurance
Auto Liability Claim Rep
Travelers —Diamond Bar, CA
- $67,000 - $110,600 a year
- Mid-level
- Analysis skills
- Bachelor's degree
- Wellness program
- Paid holidays
12d
Social Media Investigator
DigiStream Investigations —Hayward, CA
- From $21 an hour
- Full-time
- Background check
- Writing skills
- HIPAA
- Health savings account
- Health insurance
SIU Investigator
Centene —California
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Fair chance
- Paid holidays
- Health insurance
Fraud Investigator
TikTok —San Jose, CA
- $121,600 - $220,400 a year
- Finance
- Analysis skills
- Case management
- Paid parental leave
- Paid holidays
Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Sacramento, CA
- $46,988 - $112,200 a year
- Full-time
- Remote
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
2d
INVESTIGATOR
Department of Insurance —Santa Clara County, CA
- $6,339 - $10,609 a month
- Full-time
- Hybrid work
- Background check
- Mid-level
- Office
- Free parking
- Wellness program
9d
Corporate Investigator, Enterprise Protection Program - Global Investigations
Amazon.com Services LLC —Sunnyvale, CA
- $80,200 - $143,100 a year
- Full-time
- Customer service
- Mid-level
- Office
- AD&D insurance
- Health insurance
INVESTIGATOR
Department of Consumer Affairs —Contra Costa County, CA
- $6,339 - $10,609 a month
- Weekends as needed
- Hybrid work
- Pass drug screening
- Mid-level
- Office
INVESTIGATOR
Department of Health Care Services —Sacramento County, CA
- $6,339 - $10,609 a month
- Online Application
- Hybrid work
- Bilingual
- Writing skills
- Pass drug screening
- Paid holidays
- Dental insurance
12d
Commercial Bank Fraud Investigator
Avidbank —San Jose, CA
- $65,000 - $100,000 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Entry-Level Investigator
Ethos Risk Services —Riverside, CA
- From $22 an hour
- Weekends as needed
- Computer literacy
- Writing skills
- No experience needed
- Paid training
- Mileage reimbursement
Quick Apply
10d
Sr. Fraud Investigation Associate
Hyundai Capital America —Irvine, CA
- $80,000 - $120,000 a year
- Full-time
- Writing skills
- Research
- Office
- Health savings account
- Disability insurance
11d
Senior Compliance Investigator
Centene —California
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Welfare Fraud Investigator (Entry/Journey) DOQ
Solano County, CA —Fairfield, CA
- $97,136.00 - $138,902.40 a year
- Weekends as needed
- Travel
- Military encouraged
- Pre-employment physical examination
- Paid holidays
- Health insurance
9d
Welfare Fraud Investigator (Supervisor)
Solano County, CA —Fairfield, CA
- $138,777.60 - $168,688.00 a year
- Weekends as needed
- Mid-level
- 3 years
- Team management
- Paid holidays
- Health insurance
9d
Welfare Fraud Investigator (Entry/Journey) DOQ
Solano County —Fairfield, CA
- $46.70 - $66.78 an hour
- Weekends as needed
- Travel
- Military encouraged
- Pre-employment physical examination
- Paid holidays
- Health insurance
INVESTIGATOR
Department of Developmental Services - Porterville Developmental Center —Tulare County, CA
- $6,974 - $10,609 a month
- Weekends as needed
- Background check
- Mid-level
- High school diploma or GED
- Dental insurance
- Vision insurance
8d

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Compliance Investigator II

Partnership HealthPlan of California -
Fairfield, CA

Apply Now

Job Details

Full-time
$96,970.04 - $121,212.56 a year

Qualifications

Computer operation
Healthcare fraud investigations
Driver's License
Desktop applications
Typing
Productivity software
Microsoft Project

Full Job Description

Overview:

The Regulatory Affairs Specialist II has demonstrated competencies in supporting the plan-wide regulatory affairs and compliance program, including activities related to HIPAA and Fraud, Waste, and Abuse (FWA). Under supervision and direction of the Regulatory Affairs Manager, monitors daily Regulatory Affair unit’s operations to ensure the timeliness of deliverables and all case management performance metrics are met, performs internal auditing of all privacy and FWA cases to ensure they meet DHCS requirements and Partnership professional standards. Also provides support to the Regulatory Affairs Specialist (RAS), directs complex regulatory inquiries and responses to regulatory agencies.

Responsibilities:

Proficiently performs all duties of the Regulatory Specialist, independently.
Operates independently, exercising judgement, and providing support and guidance to Regulatory Affairs and Compliance (RAC) staff
Encourages continuous awareness and education of unit staff, which may include development and maintenance of training materials
Creates and monitors daily operational reports to ensure the timely submission of privacy and FWA cases to DHCS
Manages the intake and ongoing maintenance of referral/inquiry platform
Ability to assess, facilitate, and see to completion, referrals and inquiries, of varying complexity and scope, submitted to RAC
Monitors unit trackers to ensure the timeliness of deliverablesare met, making recommendation for improvements in tracking and/or work flows as necessary
Ability to direct unit work, which may include leading unit meetings/discussions and assessment of work outcomes
Competent in assessing and analyzing unit work consistent with established criteria and providing education/training to unit staff as needed
Maintains awareness and understanding of regulatory requirements that govern unit responsibilities
Makes strategic recommendation(s) to improve the accuracy, quality, and/or reporting of case investigations based on audit observations in order to enhance HIPAA and FWA case management performance
Leads or participates in Regulatory Affairs unit projects and has the capacity to represent unit in cross-departmental projects
Assists Regulatory Affairs Manager with developing and maintaining compliance training program including but not limited to:
- Updating new hire compliance trainings and annual training materials
- Conducting targeted department trainings
- Acts as a trainer for the Regulatory Affairs unit
- Backup trainer for new hire trainings or other department trainings
Works with departments on resolving complex regulatory required submissions
Assists Regulatory Affairs Manager with duties related to chairing the PTAS and FWA Subcommittees

Secondary Duties and Responsibilities

Supports regulatory submission process including awareness of deliverables, ad hoc and routine, and completeness and timeliness of submissions
Assists Regulatory Affairs and Compliance unit with the administrative functions to support unit meetings, workgroups, projects and external audits
Other duties as assigned

Qualifications:

Education and Experience

Bachelor’s degree in relevant field preferred or equivalent combination of education and experience; minimum of two (2) years’ experience as a Regulatory Affairs Specialist or relevant experience in managed care with knowledge of the Medi-Cal, and NCQA requirements, and preferably Medicare and Knox Keene. Experience with the investigation and reporting of HIPAA and FWA related incidents.

Special Skills, Licenses and Certifications

Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Project, typing speed of 30 wpm. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines. Ability to work under minimal supervision and exercise independent judgment. Diplomacy and tact in handling sensitive information regarding personnel affairs as required. Ability to interact with executives and vendors effectively, handling all assignments with efficiency. Must be able to handle multiple tasks and meet deadlines. Excellent judgment.

Work Environment And Physical Demands

Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 35 pounds.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$96,970.04 - $121,212.56

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Apply Now

Refine Your Search

insurance fraud investigator jobs in california

Compliance Investigator II

Social Media Investigator

Social Media Investigator

Auto Liability Claim Rep

Social Media Investigator

SIU Investigator

Fraud Investigator

Senior Investigator, Special Investigations Unit (Aetna SIU)

INVESTIGATOR

Corporate Investigator, Enterprise Protection Program - Global Investigations

INVESTIGATOR

INVESTIGATOR

Commercial Bank Fraud Investigator

Entry-Level Investigator

Sr. Fraud Investigation Associate

Senior Compliance Investigator

Welfare Fraud Investigator (Entry/Journey) DOQ

Welfare Fraud Investigator (Supervisor)

Welfare Fraud Investigator (Entry/Journey) DOQ

INVESTIGATOR

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