Investigator, Compliance Program Integrity Specialist
1 week ago
We are seeking a highly skilled Investigator, Compliance Program Integrity to support our San Francisco Health Plan Compliance Program. The successful candidate will conduct thorough investigations, analyze evidence, and provide recommendations to ensure compliance with regulations and internal controls.
Key Responsibilities- Conduct objective and unbiased investigations into allegations of fraud, waste, or abuse.
- Review and analyze evidence to identify fact patterns and summarize data into professional reports.
- Manage a large caseload to achieve positive results and ensure compliance.
- Communicate with internal and external stakeholders regarding auditing and monitoring activities.
- Develop and maintain a strong working knowledge of state and federal legislation, statutes, and regulations.
- Bachelor's degree in business administration or a closely related field.
- Five or more years of experience in healthcare and operations, with specialized knowledge in program integrity, state programs, and regulatory compliance.
- Certification in one of three areas: Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), or Certified Internal Auditor (CIA).
- Competitive salary range: $80,000 - $97,000.
- Hybrid work environment with a minimum of 4 days per month in-office.
- Comprehensive benefits package, including medical, dental, and vision coverage.
- Retirement plans, including CalPERS Pension and 401(a) plans.
- Professional development opportunities, including tuition reimbursement and professional license/membership.
San Francisco Health Plan is an award-winning, managed care health plan dedicated to providing affordable healthcare coverage to underserved low and moderate-income residents in San Francisco County. We are committed to a work environment that supports, inspires, and respects all individuals and promotes diversity, equity, and inclusion.
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San Francisco, California, United States San Francisco Health Plan Full timeJob SummaryWe are seeking a highly skilled Investigator, Compliance Program Integrity to support the San Francisco Health Plan (SFHP) Compliance Program through audit, investigation, and monitoring activities.Key ResponsibilitiesConduct thorough, objective, and unbiased investigations into allegations of fraud, waste, or abuse.Review and analyze evidence to...
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