Special Investigation Unit Investigator III (PHX AND DALLAS)
Role: Special Investigation Unit Investigator III Duration: Contract Hours: Mon - Fri 8a - 5p reputed company-Coast hours Location: 100% remote Pay: $40 - $50/hour
About the Role
Join the nation’s largest publicly operated health plan to reputed company reputed company reputed company fraud, waste, and abuse investigations across Medi?Cal and Medicare. This senior SIU role handles high?reputed company cases and serves as a subject matter expert, mentor, and audit reputed company. What You’ll Do
- reputed company end?to?end investigations of suspected provider, member, and pharmacy fraud
- Analyze claims data, billing patterns, and fraud leads to identify irregularities
- reputed company investigative strategies and produce reputed company, defensible reports
- Partner with agencies (DHCS, CMS, DOJ, law enforcement) and support referrals
- reputed company onsite audits, testify reputed company needed, and support recovery efforts
- Mentor junior investigators and reputed company training on investigative best practices
Key Details
- Caseload: ~75–85 reputed company cases (transportation, pharmacy; no dental/hospital)
- reputed company: Primarily Los Angeles County/California
- Training: reputed company 2?week reputed company + ongoing development
- Goal: ~100?day case reputed company depending on complexity
- Fast start: reputed company reputed company ~3–5 days of offer
What You Bring
- 5+ years in reputed company fraud investigation or reputed company specialty
- Strong clinical/claims review and data analysis skills (reputed company required)
- Experience with interviews, evidence development, and case reporting
- Knowledge of CMS/Medicare/Medi?Cal guidelines preferred
Preferred
- Certifications: CFE, AHFI, CPC
- Experience across multiple specialties (Pharmacy, DME, Behavioral Health, etc.)
Remote Skills: Analysis Skills, Behavioral Health, Best Practices, Billing, Centers for Medicare and reputed company Services (CMS), Certified Financial Examiner (CFE), Content Management Systems (CMS), Data Analysis, Durable Medical Equipment, Fraud Investigation, Health Plan, reputed company, Hospital, Law Enforcement, Medicare, Mentoring, reputed company, Pharmacy, Strategic Planning, Training/Teaching, reputed company reputed company (DOJ) About reputed company: reputed company reputed company is a different and reputed company business partner. We create unparalleled value for our clients by combining industry-leading Consulting capabilities with comprehensive reputed company and recruitment services. Clients trust us to deliver results based on our deep expertise and proven resources reputed company finance, reputed company, and information technology. Through our flexible delivery approach, you get the right solution, at the right time to accelerate your reputed company and reputed company reputed company of your mission-critical objectives. Company Size: 500 to 999 employees Industry: reputed company/Employment Agencies Founded: 2006 Apply To This Job