Special Investigation Unit Investigator III
L.A. Care Health Plan —Los Angeles, CA
- $88,854 - $142,166 a year
- Full-time
- 5 years
- Research
- Master's degree
- Wellness program
- Health insurance
Field Investigator (Full-Time & Part-Time) – Los Angeles, CA
Origin Investigations Inc —Los Angeles, CA
- $25 - $40 an hour
- Part-time
- Background check
- Military
- Computer literacy
Quick Apply
Surveillance Investigator
Frasco Inc —Los Angeles, CA
- $20 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- High school diploma or GED
- Paid training
- Mileage reimbursement
Manager, Special Investigations Unit
L.A. Care Health Plan —Los Angeles, CA
- $102,183 - $163,492 a year
- Full-time
- Writing skills
- Office
- 3 years
- Wellness program
- Health insurance
Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse
L.A. Care Health Plan —Los Angeles, CA
- $135,136 - $216,218 a year
- Full-time
- Spanish
- 5 years
- English
- Wellness program
- Health insurance
Surveillance Investigator
VRC Investigations —Anaheim, CA
- $25 - $30 an hour
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
7d
Senior Compliance Investigator
UCLA Health —Los Angeles, CA
- $108,900 - $241,500 a year
- Master's degree
- Databases
- Analysis skills
Financial Security Investigations Officer
Rize Beyond Banking —Irwindale, CA
- $77,000 - $100,000 a year
- Full-time
- Hybrid work
- Spanish
- Microsoft Excel
- 5 years
Quick Apply
4d
Affirmative Civil Enforcement (ACE) Investigator
Contact Government Services, LLC —Los Angeles, CA
- $51,435.30 - $66,131.10 a year
- Full-time
- Hybrid work
- Microsoft Access
- Microsoft Outlook
- Office
- Health insurance
- Dental insurance
Quick Apply
A/P Area Investigator D5
Vallarta Supermarkets —Pasadena, CA
- $22.50 - $26.00 an hour
- Weekends as needed
- 18 years or older
- Ability to walk for extended periods
- Mid-level
Quick Apply
Audit/Investigation Coordinator II
Qlarant —Los Alamitos, CA
- $32,240 - $47,412 a year
- Full-time
- Mid-level
- High school diploma or GED
Quick Apply
Director, Special Investigations Unit - AHFI
SCAN Group —Long Beach, CA
- $147,000 - $190,000 a year
- Full-time
- Background check
- Bachelor's degree
- Older adults
- Wellness program
- Paid holidays
Quick Apply
A/P Area Investigator D1
Vallarta Supermarkets —Sylmar, CA
- $22.50 - $26.00 an hour
- Weekends as needed
- 18 years or older
- Ability to walk for extended periods
- Mid-level
Quick Apply
Senior Financial Investigator
Contact Government Services, LLC —Los Angeles, CA
- $74,156.16 - $107,114.45 a year
- Full-time
- Hybrid work
- Mid-level
- Driver's License
- Presentation skills
- Health insurance
- Dental insurance
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Los Angeles, CA
- $20 - $24 an hour
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
In-House Private investigator
USA Express Legal & Investigative Service Inc. —Woodland Hills, CA
- $30 - $35 an hour
- Full-time
- Mid-level
- Analysis skills
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Senior Investigator Pharmacy - Los Angeles County, CA
UnitedHealthcare —Los Angeles, CA
- $60,200 - $107,400 a year
- Full-time
- Remote
- Microsoft Word
- Up to 50% travel
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
Director, Investigations - Crypto Fraud and Market Abuse
Financial Industry Regulatory Authority, Inc. —Los Angeles, CA
- $134,400 - $312,600 a year
- Extended hours
- Hybrid work
- CPA
- Research
- Office
- Paid jury duty
- Commuter assistance
Quick Apply
2d
Retail Asset Protection Investigator - WeHo
The RealReal —Los Angeles, CA
- $22.50 - $26.27 an hour
- Full-time
- Writing skills
- Mid-level
- Ability to lift 50 pounds
- Paid parental leave
- Employee stock purchase plan
Quick Apply
As Needed Field Investigator- Long Beach, CA
J T Becker & Co Inc —Long Beach, CA
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply

I want to receive the latest job alert for fraud investigator in los angeles, ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

fraud investigator jobs near los angeles, ca

Fraud Investigator jobs in Los Angeles, CA

Field Investigator jobs in Los Angeles, CA

Surveillance Investigator jobs in Los Angeles, CA

Director Of Compliance jobs in Los Angeles, CA

Senior Special Agent jobs in Los Angeles, CA

Unit Manager jobs in Los Angeles, CA

Asset Protection Investigator jobs in Los Angeles, CA

Senior Pharmacy Technician jobs in Los Angeles, CA

Surveillance Investigator jobs in Charleston, WV

Surveillance Investigator jobs in Minnesota

Fire Investigator jobs in Pennsylvania

Surveillance Investigator jobs in West Virginia

Civilian Investigator jobs in Dallas, TX

Private Investigator jobs in Fairfax, VA

Surveillance Investigator jobs in Gwinnett County, GA

Private Security jobs in Los Angeles, CA

Fraud Investigator jobs in Minneapolis, MN

Private Investigator jobs in Macomb County, MI

Private Investigator jobs in Kansas City, MO 64118

Private Duty Caregiver jobs in Cincinnati, OH

Special Investigation Unit Investigator III

L.A. Care Health Plan -
Los Angeles, CA

Apply Now

Job Details

Full-time
$88,854 - $142,166 a year

Benefits

Wellness program
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

Investigative interviewing techniques
Spreadsheets
Research
Mentoring
Productivity software
Legal compliance

Full Job Description

Special Investigation Unit Investigator III

Job Category: Administrative, HR, Business Professionals

Department: Special Investigations Unit

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13231

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. In addition, this position is responsible for building the investigative approach and provide leadership for Investigators through mentoring, on-site audit leadership and hands-on training of investigative techniques.

Responsible for in-depth investigations requiring subject matter expertise for suspected provider, pharmacy, employer or member fraud or abuse across all products at L.A. Care Health Plan. Ensures adherence to L.A. Care's policies and procedures for its various product offerings. Conducts investigation-related training. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Investigates allegations and complex issues pertaining to potential health care fraud by providers or members. Makes potential fraud & abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. Proactively seeks out and develops leads received from fraud tips and any variety of sources (e.g., fraud alerts, media) and initiates appropriate action. Writes comprehensive investigatory/fact-finding reports and summaries documenting interviews and findings. Reviews information contained in standard claims processing system files (e.g. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action. This position is a leader at onsite audits as assigned in conjunction with investigation development. Completes investigations after referrals to law enforcement (Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) or local police). Participates at hearings/appeals and can testify as a witness in court proceedings. Initiates the process with L.A. Care’s Recovery Services for recoupment of overpaid monies.

Submits referrals of suspected fraud cases within mandated period of time as required by DHCS and CMS. Prepares and submits investigative report documenting all phases of an investigation. Compiles and maintains various documentation and other reporting requirements while following all confidentiality and security guidelines. Maintains cases referred to law enforcement and responds to requests for information; pursues applicable administrative actions during investigation/case development.

Participates in industry meetings/trainings and is able to effectively share and gather significant information. Develops and maintains strong working relationships with associates and regulators including DHCS, DOJ the FBI, Local Law Enforcement, Prosecutors, etc. Continually enhances investigative skills and understanding of emerging issues and trends impacting the industry.

Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree in Criminal Justice or Related Field

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Criminal Justice or Related Field

Experience

Required:

Minimum of 5 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.

Experience conducting fact-finding interviews or investigations to gather information and draw conclusions from various accounts and versions of the same event.

Experience managing large amounts of data including pivot tables, complex calculations, and ability to perform comparisons across multiple large data sets

Preferred:

Diverse experience as subject matter expert (SME) with multiple specialties including: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.

Skills

Required:
Excellent research skills and the ability to support conclusions with documentary evidence.

Excellent analytical, problem solving, and resolution skills and the ability to discern the practical application of regulatory and legal requirements.

Demonstrated strong organizational skills and the ability to manage multiple demands and priorities.

Excellent and effective communication skills, both verbal and written.

Proficient computer skills, including computer applications such as MS Word and Excel.

Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.

Ability to maintain in-depth working knowledge of fraud investigation techniques and mentor less experienced team members.

Preferred:

Proficiency with Access.

Licenses/Certifications Required

Licenses/Certifications Preferred

Accredited Health Care Fraud Investigator (AHFI)

Certified Fraud Examiner (CFE)

Certified Professional Coder (CPC) designation by the American Academy of Professional Coders

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles
Job Segment: Medical Coding, Pharmacy, Claims, Counseling, Behavioral Health, Healthcare, Insurance

Apply Now

Refine Your Search

fraud investigator jobs in los angeles, ca

I want to receive the latest job alert for fraud investigator in los angeles, ca

Related Searches

Explore jobs in more locations

Special Investigation Unit Investigator III

Job Summary

Duties

Duties Continued

Education Required

Education Preferred

Experience

Skills

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information