Sr Fraud, Waste and Abuse Investigator; Investigator Sr

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr)and help shape the future of healthcare where you’ll be an integral part of our OOC - Fraud & Waste
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be
Partial Telework
.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

Under general direction, the Investigator Sr for Fraud, Waste & Abuse (FWA) will support the detection, prevention, investigation, mitigation and reporting of FWA issues. You'll conduct investigations of medical providers, pharmacies, Cal Optima Health, health networks and members from case management to resolution and identifies over payment of funds. Additionally, you'll work with internal departments, legal counsel, medical directors and external entities as appropriate to achieve and maintain appropriate anti-fraud oversight.

Together, we are building a stronger, more equitable health system.

• 95% - Investigative Functions
  • Analyzes the results of the investigation to ascertain if the allegations have been