Special Investigations Unit Investigator

This is a fully remote position, open to applicants in Arizona, +7 more states.

📋 Description

• Oversee fraud, waste, and abuse responsibilities for CareOregon and its associated lines of business.

• Create and implement a robust FWA program that complies with CMS, OHA/OHP, and relevant legal standards.

• Conduct regular FWA investigations, audits, and implement corrective measures.

• Keep investigation documentation organized and provide regular updates.

• Support senior investigators with intricate or advanced investigations.

• Draft reports detailing audit findings and suggest enhancements or corrective measures.

• Prepare, review, and circulate specialized and confidential correspondence, forms, and information.

• Address routine and ad hoc inquiries from external regulatory bodies.

• Compile reports for internal and external leaders, committees, and governing bodies by gathering, analyzing, and presenting data.

• Create and sustain documentation systems to meet FWA regulatory requirements.

• Evaluate and propose revisions to FWA/SIU policies and procedures.

• Participate in FWA and compliance-related meetings.

• Assist with FWA training and educational programs for both internal and external personnel.

• Guide providers on proper documentation and coding practices.

• Engage in FWA risk assessment and mitigation strategies.

• Achieve departmental key performance indicator metrics.

• Execute work in alignment with CareOregon’s mission, vision, values, and strategic objectives.

• Comply with organizational policies, procedures, and regulatory requirements.

⛳️ Requirements

• At least 2 years of experience in FWA, compliance, and/or auditing, preferably in an operational environment within a highly regulated sector.

• Knowledge of healthcare fraud, waste, and abuse.

• Familiarity with the distinctions between State Medicaid programs and Medicare.

• Understanding of State and Federal compliance and FWA standards for Medicare and Medicaid.

• Proficient in investigative techniques such as interviews, data analysis, evidence collection, and case documentation.

• Basic understanding of information systems.

• Strong research, investigative, and analytical problem-solving abilities.

• Excellent written, verbal, and listening communication skills.

• Proficient in computer skills, particularly with the MS Office Suite.

• Strong interpersonal and motivational abilities.

• Capability to think logically and creatively without undue influence from personal biases.

• Ability to operate with a high level of professionalism and confidentiality.

• Skills in planning, organizing, managing, and overseeing work projects.

• Capacity to facilitate learning opportunities in both informal and formal environments.

• Ability to deliver presentations to both small and large audiences.

• Ability to bend and speak clearly for a minimum of 3 hours per day.

• Ability to learn, concentrate, comprehend, evaluate information, and determine suitable actions.

• Ability to accept direction and feedback, manage stress, and maintain composure.

• Ability to see, read, and hear for at least 6 hours a day.

• Ability to perform repetitive finger and wrist movements for 3 to 6 hours daily.

• Ability to collaborate effectively with a diverse range of individuals and groups.

🏝️ Benefits

• Bonus - SIP Target, 5% Annual.

• Comprehensive 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.

• Additional benefits including optional life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings.

• Retirement plan with employer contributions.

• Paid Time Off (PTO).

• Paid State Sick Time.

• Paid holidays.

• Volunteer time off.

• Jury duty leave.

• Bereavement leave.

• 401(k) contributions for employees not eligible for benefits.

• Wellness and employee assistance program benefits for non-benefits eligible employees.