Inland Empire Health Plan
Lead Investigator - Special Investigations Unit
Inland Empire Health Plan, Rancho Cucamonga, California, United States, 91739
Lead Investigator - Special Investigations Unit
What you can expect!
Find joy in serving others with IEHP. We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience. Responsibilities and Qualifications
The Lead Investigator is responsible for investigating and resolving high complexity allegations of healthcare Fraud, Waste and Abuse (FWA) by medical professionals, facilities and members. The position researches, gathers and analyzes data to identify trends, patterns, aberrancies and outliers in provider billing behavior. The incumbent serves as a subject matter expert for other investigators and works collaboratively within the Plan to ensure proper oversight of IEHP’s FWA Programs. Key qualifications include comprehensive knowledge of managed care and Medicare programs, strong analytical and project management skills, excellent communication skills, proficiency in Microsoft Office and data analytics, and proven ability to lead a team and manage multi‑tasks. Perks Competitive salary Hybrid schedule CalPERS retirement State‑of‑the‑art fitness center on‑site Medical, dental and vision insurance Life, short‑term and long‑term disability coverage Career advancement and professional development opportunities Wellness programs promoting a healthy work‑life balance Flexible Spending Account for health care and childcare 457(b) plan with contribution match Pet care insurance Education & Requirements Six (6)+ years of relevant experience in a healthcare environment with an emphasis in fraud, waste and abuse investigations, including federal and state reporting requirements. Bachelor’s degree from an accredited institution (preferred). Master’s degree from an accredited institution preferred. Accredited Healthcare Fraud Investigator (AHFI) certification required; candidates without current certification must obtain it within twenty‑four (24) months of hire date. Pay Range $50.02 USD hourly – $66.27 USD hourly
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What you can expect!
Find joy in serving others with IEHP. We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience. Responsibilities and Qualifications
The Lead Investigator is responsible for investigating and resolving high complexity allegations of healthcare Fraud, Waste and Abuse (FWA) by medical professionals, facilities and members. The position researches, gathers and analyzes data to identify trends, patterns, aberrancies and outliers in provider billing behavior. The incumbent serves as a subject matter expert for other investigators and works collaboratively within the Plan to ensure proper oversight of IEHP’s FWA Programs. Key qualifications include comprehensive knowledge of managed care and Medicare programs, strong analytical and project management skills, excellent communication skills, proficiency in Microsoft Office and data analytics, and proven ability to lead a team and manage multi‑tasks. Perks Competitive salary Hybrid schedule CalPERS retirement State‑of‑the‑art fitness center on‑site Medical, dental and vision insurance Life, short‑term and long‑term disability coverage Career advancement and professional development opportunities Wellness programs promoting a healthy work‑life balance Flexible Spending Account for health care and childcare 457(b) plan with contribution match Pet care insurance Education & Requirements Six (6)+ years of relevant experience in a healthcare environment with an emphasis in fraud, waste and abuse investigations, including federal and state reporting requirements. Bachelor’s degree from an accredited institution (preferred). Master’s degree from an accredited institution preferred. Accredited Healthcare Fraud Investigator (AHFI) certification required; candidates without current certification must obtain it within twenty‑four (24) months of hire date. Pay Range $50.02 USD hourly – $66.27 USD hourly
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