Job Description

Salary: $123,000 - 163,000 per year Requirements:

• We require experience in a similar role, or strong knowledge and capability to carry out the duties of the position successfully.
• We consider relevant education and/or training an advantage.

• We review allegations and complex matters involving potential healthcare fraud, waste, and abuse across providers, pharmacies, employers, and members.
• We analyze claims data, provider details, and other records to uncover unusual billing patterns, trends, and areas of concern.
• We research and collect pertinent information from internal and external sources, including fraud referrals, public records, industry publications, and media coverage.
• We document investigative work, findings, interviews, and supporting evidence in clear reports and summaries.
• We examine claims systems, provider files, and related databases to identify billing irregularities and possible compliance issues.
• We take part in onsite reviews, audits, and information-gathering assignments as needed.
• We maintain case documentation and files in line with company policy, confidentiality standards, and regulatory requirements.
• We prepare reports and supporting materials for internal partners and designated regulatory or compliance teams.
• We respond to information requests and support ongoing case tracking and recordkeeping.
• We participate in industry meetings, professional development, and training to stay current on emerging fraud trends and investigative methods.
• We build and sustain effective relationships with internal teams, regulatory bodies, and other external stakeholders.
• We apply our subject matter expertise to support business operations, process improvements, and investigative reviews.
• We identify opportunities to improve workflows, reporting, and analytical processes.
• We provide guidance, knowledge sharing, and training support to team members when needed.

• Support
• AI
• LESS

More:

We are hiring a SIU Investigator for our healthcare client in Los Angeles. We offer comprehensive benefits to eligible employees, including medical, dental, and vision insurance, HSA, FSA, 401(k), and life, disability, and ADD insurance. Salaried employees receive paid time off, and hourly employees may receive sick leave when required by law. This role is not eligible for bonuses, incentives, or commissions. We are an equal opportunity employer committed to fair consideration for all qualified applicants.

last updated 27 week of 2026

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