Compliance Investigator

9 hours ago


San Francisco, California, United States San Francisco Health Plan Full time
Job Summary

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.
Requirements
  • 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.
What We Offer
  • 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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