Starting Salary: $50,835.20 - $64,792.00. Pay rate will commensurate with experience
Under the direction of the Manager – Special Investigations Unit, the Fraud Investigator I has general knowledge and performs routine investigations, activities, and initiatives of moderate difficulty related to the Fraud, Waste and Abuse Program. The Fraud Investigator I is responsible to proactively prevent, detect, and correct identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and/or Federal regulatory agencies, while monitoring and maintaining a framework to ensure compliance with State and/or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC) and the California Department of Health Care Services (DHCS).
Two (2) or more years of relevant professional experience in a health care environment. Experience in fraud, waste and abuse investigations, medical billing, pharmacy claims, or claims processing preferred
Bachelor’s degree from an accredited institution required. Significant experience may be considered in lieu of degree: In lieu of a degree, a minimum of 6 years of relevant work experience is required.
Compliance principles and practices of managed care, FWA activities and medical terminology.
Interpersonal and presentation skills to communicate with internal departments and external agencies. Effective communication skills; verbal and written. Strong organizational skills and attention to detail. Good computer skills and proficiency in Microsoft Office programs including, but not limited to: Word; Excel; PowerPoint; Outlook; and Access.
Ability to work independently with minimal direction on recurring tasks. Work collaboratively within a team environment. Manage projects with competing deadlines and changing priorities. Critical thinking and sound analytical reasoning.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Internal Number: 4557
About Inland Empire Health Plan (IEHP)
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire, celebrating 25 years! We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.