Hybrid Program Integrity Investigator

San Francisco Health Plan; San Francisco (CA); Sur place; USD 100 000 - 115 000; Plein temps

Avantages offerts par ce poste

Medical plans

Dental plans

Vision coverage

Retirement plans (CalPERS, 401a, 457)

Paid time off

Professional development

Résumé du poste

San Francisco Health Plan (SFHP) seeks an Investigator, Program Integrity to lead investigations, audits, and monitoring within the Compliance program. You will independently manage a caseload, analyze evidence, and prepare professional reports with findings and recommendations.

You will coordinate internal and external audits, strengthen internal controls, and support the annual workplan and Medicare D-SNP framework. SFHP requires onsite presence and offers comprehensive benefits.

Qualifications

• Bachelor’s degree or equivalent experience required.
• Minimum of five years in healthcare operations and compliance.
• CPC, AHFI, or CIA certifications preferred.

Responsabilités

• Conduct objective investigations into fraud, waste, or abuse and related audits.
• Manage a caseload and provide management with summary reports.
• Review evidence to analyze case fact patterns and recommendations.
• Document steps and findings in formal investigative reports.
• Present progress and findings in reports and meetings.
• Evaluate records to ensure regulatory compliance and control strength.
• Prepare special audit and management reports from data trends.
• Contribute to annual workplan and Medicare D-SNP framework.

Connaissances

Investigations

Audits

Data analysis

Report writing

Communication

Formation

Bachelor’s degree in business administration or related field

Description du poste

San Francisco Health Plan (SFHP) seeks an Investigator, Program Integrity to lead investigations, audits, and monitoring within the Compliance program. You will independently manage a caseload, analyze evidence, and prepare professional reports with findings and recommendations.

You will coordinate internal and external audits, strengthen internal controls, and support the annual workplan and Medicare D-SNP framework. SFHP requires onsite presence and offers comprehensive benefits.