Special Investigations Unit Investigator
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Special Investigations Unit Investigator administering CareOregon’s healthcare fraud, waste, and abuse program. Conducting investigations, audits, reporting, corrective actions, and provider education.
Responsibilities:
- Administer fraud, waste, and abuse duties for CareOregon and affiliated lines of business
- Develop and operate an effective FWA program in accordance with CMS, OHA/OHP, and applicable legal requirements
- Perform routine FWA investigations, audits, and corrective actions
- Maintain investigation documents and provide routine updates
- Assist senior investigators with complex or advanced investigations
- Prepare reports of audit findings and recommend improvements or corrective actions
- Prepare, proofread, and distribute specialized and confidential correspondence, forms, and information
- Respond to routine and ad hoc requests from external regulatory agencies
- Prepare reports for internal and external leaders, committees, and governing bodies by collecting, analyzing, and displaying data
- Develop and maintain documentation systems for FWA regulatory requirements
- Review and recommend FWA/SIU policy and procedure revisions
- Attend FWA and compliance-related meetings
- Assist with FWA training and education for internal and external staff
- Educate providers on appropriate documentation and coding
- Participate in FWA risk assessment and mitigation processes
- Meet departmental key performance indicator metrics
- Perform work aligned with CareOregon’s mission, vision, values, and strategic goals
- Adhere to organizational policies, procedures, and compliance requirements
Requirements:
- Minimum 2 years’ experience in FWA, compliance and/or audit including in an operational setting within a highly regulated industry
- Understanding of healthcare fraud, waste, and abuse
- Understanding the difference between State Medicaid programs and Medicare
- Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid
- Knowledge of investigative techniques including interviews, data analytics, evidence gathering, and case documentation
- Understanding of information systems
- Strong research, investigative, and problem-solving skills
- Strong written, verbal, and listening skills
- Effective computer skills, including MS Office Suite
- Strong interpersonal and motivational skills
- Ability to think logically and creatively without undue influence from personal biases
- Ability to operate with a high degree of professionalism and confidentiality
- Ability to plan, organize, manage, and monitor work projects
- Ability to facilitate learning opportunities in informal and formal settings
- Ability to make presentations to small and large groups
- Ability to bend and speak clearly for at least 3 hours/day
- Ability to learn, focus, understand, evaluate information, and determine appropriate actions
- Ability to accept direction and feedback, tolerate and manage stress
- Ability to see, read, and hear for at least 6 hours/day
- Ability to perform repetitive finger and wrist movement for at least 3–6 hours/day
- Ability to work effectively with diverse individuals and groups
Benefits:
- Bonus - SIP Target, 5% Annual
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account
- Flexible spending account(s)
- Lifestyle spending account
- Employee assistance program
- Wellness program
- Discounts
- Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings
- Retirement plan with employer contributions
- PTO
- Paid State Sick Time
- Paid holidays
- Volunteer time
- Jury duty leave
- Bereavement leave
- 401(k) contributions for non-benefits eligible employees
- Wellness and employee assistance program benefits for non-benefits eligible employees
Similar Jobs
Special Investigation Unit Investigator
Special Investigation Unit Investigator investigating healthcare fraud, waste, and abuse for Centene. Reviewing claims and records, preparing case reports, and supporting program integrity recoveries.
Civil Rights/Title IX Investigator
Civil rights investigator conducting impartial Title IX and discrimination investigations for education risk-management consultancy. Producing evidence-based reports and training institutional stakeholders.
Clinical Trial Investigator, Grant Forecasting
Clinical trial grant forecasting specialist supporting Thermo Fisher Scientific, a global science-services company. Building payment forecasts, dashboards, variance analyses, and scenarios across clinical studies and countries.
SIU Investigator
SIU Investigator conducting Workers’ Compensation and other insurance-claim fraud investigations for Delta Group. Interviewing claimants and witnesses, analyzing evidence, and reporting findings to insurers and clients.
Investigator Payments Lead – Associate
Investigator payments lead managing clinical site payments for Parexel, a global clinical research organization. Overseeing budgets, contracts, payment systems, vendors, and issue resolution across clinical trials.
Investigator Payments Lead – Senior Associate
Investigator Payments Lead managing clinical site payments, budgets, contracts, and vendor oversight for Parexel, a global clinical research organization. Supporting timely, accurate payments across clinical trials from study startup through closeout.
Investigator Payments Lead – Associate, Clinical Site Payments Lead – Associate
Investigator Payments Lead supporting Parexel’s global clinical trials from Romania. Managing site payment systems, budgets, contracts, vendors, and payment issue resolution.
Investigator Payments Lead – Senior Associate
Investigator Payments Lead managing clinical site payments for Parexel, a global clinical research organization. Overseeing budgets, contracts, payment systems, vendors, and payment execution across clinical trials.
Fire Investigator
Fire Investigator conducting origin-and-cause investigations for EFI Global, a forensic engineering and specialty consulting firm. Determining responsibility and delivering defensible findings across Texas.
Investigator, Grants Specialist
Investigator Grants Specialist forecasting and costing clinical-trial grants for Worldwide Clinical Trials, a global CRO. Collaborating across commercial, project, clinical, and site-activation teams.
Investigator Payments Lead – Senior Associate
Investigator Payments Lead managing clinical site payments for Parexel, a global clinical research organization. Overseeing budgets, contracts, payment systems, vendors, and study payment execution.
Investigator II – Special Investigations Unit, Tennessee, North Carolina, Kentucky, Virginia
Investigator II handling insurance fraud investigations for West Bend, focusing on various personal, commercial, and specialty lines. Collaborating with internal stakeholders and external partners to evaluate and investigate suspicious transactions.
Senior Fire Investigator, IAAI-CFI
Fire Investigator conducting origin and cause investigations for EFI Global in a remote role. Seeking a self-directed professional with IAAI-CFI certification preferred and a commitment to integrity.
Senior Investigator
Senior Investigator managing fraud, waste, and abuse audits across independent teams at PacificSource. Conducting investigations and ensuring compliance with regulations and company policies.
Retail Crime Investigator
Retail Crime Investigator role with Weis Markets managing investigations of external theft. Responsible for collaborating with law enforcement and providing investigative support across multiple locations.
Investigator Support Coordinator – German/French/Italian Speaker
Remote Investigator Support Assistant notifying investigator sites of lab results and supporting inquiries. Requires fluency in English and Italian, German, or French.
Senior Fire Investigator – IAAI-CFI
Senior Fire Investigator conducting origin and cause investigations for EFI Global in the Dallas area. Collaborating with multidisciplinary teams to deliver unbiased findings in fire investigations.
Fire Investigator – IAAI-CFI
Fire Investigator conducting origin and cause investigations for EFI Global. Collaborating with a multidisciplinary team to provide reliable conclusions and exceptional service across the region.
Senior Investigator
Senior Investigator leading complex OSINT investigations to protect intellectual property rights. Collaborating with global teams in the Special Investigations Unit to combat infringement worldwide.
Senior Investigator
Senior Investigator leading complex OSINT investigations aimed at dismantling criminal operations. Focusing on intellectual property protection using advanced techniques and digital intelligence tools.