Compliance Investigator
9 hours ago
We are seeking a highly skilled Compliance Investigator to join our team at San Francisco Health Plan. As a key member of our Compliance Program, you will play a critical role in ensuring the integrity of our operations and maintaining compliance with regulatory requirements.
Key Responsibilities- Conduct thorough investigations into allegations of fraud, waste, and abuse, analyzing evidence and summarizing findings in professional reports.
- Manage a large caseload, achieving positive results and communicating effectively with internal and external stakeholders.
- Ensure compliance with regulations and controls, examining and analyzing records, reports, and operating practices to identify areas for improvement.
- Prepare investigative reports and memorandums, documenting investigative steps and findings.
- Develop and maintain a strong working knowledge of state and federal legislation, statutes, and regulations, as well as local, state, and national health issues affecting publicly funded managed care organizations.
- Bachelor's degree in business administration or a closely related field, or equivalent experience.
- Certification in one of three areas: Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), or Certified Internal Auditor (CIA).
- Five or more years of experience in healthcare and operations, with specialized knowledge in program integrity, state programs, Medicare and Medicaid programs, regulatory compliance, and antifraud activities.
- Certification in healthcare compliance is preferred.
- Competitive salary range: $80,000 - $97,000.
- Comprehensive benefits package, including medical, dental, and vision coverage.
- Retirement plans, including a CalPERS pension and 401(a) plans.
- Generous time-off policy, including 23 days of paid time off and 13 paid holidays.
- Professional development opportunities, including tuition reimbursement and professional license/membership support.
San Francisco Health Plan is an equal opportunity employer, committed to a work environment that supports, inspires, and respects all individuals. We are proud to be an E-Verify participating employer and prioritize hiring candidates residing in the San Francisco Bay Area and California.
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Compliance Investigator
22 hours ago
San Francisco, California, United States San Francisco Health Plan Full timeJob SummaryWe are seeking a highly skilled Compliance Investigator to join our team at San Francisco Health Plan. As a Compliance Investigator, you will play a critical role in supporting our Compliance Program through audit, investigation, and monitoring activities.Key ResponsibilitiesConduct thorough and unbiased investigations into allegations of fraud,...
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Surveillance Investigator
2 weeks ago
San Jose, California, United States Allied Universal® Compliance and Investigations Full timeJob Title: Surveillance InvestigatorJoin Allied Universal Compliance and Investigations as a Surveillance Investigator and take your career to the next level in the insurance industry.Job SummaryWe are seeking a skilled Surveillance Investigator to conduct discreet mobile and stationary surveillance of claimants to confirm their current activities and...
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Surveillance Investigator
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Insurance Investigator
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San Diego, California, United States LPL Financial Holdings, Inc. Full timeJob SummaryThe Senior Vice President of Employee Investigations and Compliance plays a critical role in shaping the work environment by fostering positive relationships between the organization and its employees. This position is responsible for developing and implementing strategies, policies, and practices that promote a culture of respect, fairness, and...
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Deputy Director of Investigations
4 weeks ago
San Francisco, California, United States University of California , San Francisco Full timeJob SummaryWe are seeking a highly skilled and experienced Deputy Director of Investigations to join our team at the University of California, San Francisco. As a key member of our Ethics and Compliance department, you will be responsible for managing a team of professionals, providing policy and staffing recommendations, and acting as the Title IX/EEO...
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Deputy Director of Investigations
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San Francisco, California, United States University of California , San Francisco Full timeJob SummaryThe Deputy Director of Investigations manages a team of Ethics and Compliance Professionals, providing policy and staffing recommendations to the Title IX/EEO Officer. The incumbent serves as a subject-matter expert on all related laws and regulations, as well as institutional policies and procedures. They lead activities related to audit,...
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Regulatory Investigator
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Deputy Director of Investigations
2 weeks ago
San Francisco, California, United States University of California Full timeJob SummaryThe Deputy Director of Investigations is a key member of the Office of Diversity and Outreach (ODO) at the University of California, San Francisco (UCSF). This role is responsible for managing a team of Ethics and Compliance Professionals, providing policy and staffing recommendations to the Title IX/EEO Officer, and acting as the Title IX/EEO...
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Deputy Director of Investigations
4 weeks ago
San Francisco, California, United States University of California , San Francisco Full timeJob SummaryThe University of California, San Francisco (UCSF) is seeking a highly skilled Deputy Director of Investigations to join our team. As a key member of our Office of Diversity and Outreach (ODO), you will play a critical role in ensuring compliance with federal and state laws, as well as university policies and regulations.Key ResponsibilitiesManage...
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Vehicle Safety Investigator
3 weeks ago
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Special Investigator
3 weeks ago
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SIU Claims Investigator
3 weeks ago
San Francisco, California, United States USAA Full timeJob Title: SIU Case ManagerWe are seeking a highly skilled SIU Case Manager to join our team at USAA. As a SIU Case Manager, you will play a critical role in evaluating and concluding claims identified by SIU Investigators as having elements of fraud or an intentional act.Key Responsibilities:Review investigative findings of claims identified as having...
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Vehicle Safety Investigations Engineer
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San Francisco, California, United States Hyundai Motor America Full timeJob SummaryWe are seeking a highly skilled Vehicle Safety Investigations Engineer to join our team at Hyundai Motor America. As a key member of our safety team, you will be responsible for identifying and defining safety, compliance, and regulatory concerns on Hyundai and Genesis models.Key ResponsibilitiesConduct thorough investigations into consumer...
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Vehicle Safety Investigations Engineer
1 month ago
San Francisco, California, United States Hyundai Motor America Full timeAbout the RoleWe are seeking a highly skilled Vehicle Safety Investigations Engineer to join our team at Hyundai Motor America. As a key member of our safety team, you will be responsible for identifying and defining safety, compliance, and regulatory concerns on Hyundai and Genesis models.Key ResponsibilitiesConduct thorough investigations into consumer...
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AML Compliance Specialist
1 day ago
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Special Investigator
4 weeks ago
San Francisco, California, United States Department of Consumer Affairs Full timeJob Description and DutiesThe Department of Consumer Affairs is seeking a Special Investigator to join the Enforcement Division. As a key member of the team, you will be responsible for investigating consumer complaints related to the Contractors State License Law.Key Responsibilities:Conduct thorough investigations of consumer complaints, including complex...
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Compliance Specialist
2 weeks ago
San Francisco, California, United States Clark Construction Group Full timeCompliance Analyst Job DescriptionThe Compliance Analyst serves as a key member of the Project Controls and Compliance department, ensuring that our government-funded construction projects meet their compliance objectives. This entry-level role offers opportunities for growth and development within the company.Responsibilities:Enforce compliance with...
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Compliance Specialist
3 weeks ago
San Francisco, California, United States Clark Construction Group Full timeJob Title: Compliance AnalystThe Compliance Analyst plays a critical role in ensuring the compliance of Clark Construction Group's government-funded construction projects. This position requires a highly motivated individual with strong organizational and time management skills to work alongside a dedicated team of compliance...
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