Lead SIU Investigator: Healthcare Fraud & Data Analytics

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 89,000 - 142,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan seeks a Lead Special Investigations Unit Investigator to oversee investigations, guide provider training communications, and conduct data analysis for fraud detection. The role includes handling investigations, reporting, and referrals to law enforcement.

The position requires at least 5 years in healthcare fraud investigation, advanced analytical ability, and strong communication skills to support complex cases across the organization and with external agencies.

Qualifications

• Bachelor's degree in Criminal Justice or Accounting; in lieu of degree, equivalent education/experience may be considered.
• Master's degree preferred in Criminal Justice or Accounting.

Responsibilities

• Lead investigations into suspected fraud, waste, or abuse with oversight of data analysis and reporting.
• Provide training communications and documentation guidance within SIU.
• Prepare investigation reports and make referrals to law enforcement (DHCS, CMS, DOJ, local police).
• Lead CMS Fraud Waste and Abuse training program for providers.
• Testify as a witness in court and participate in hearings/appeals.

Skills

Lead experience

Research skills

Analytical skills

Communication skills

Organizational skills

MS Word

Excel

Education

Bachelor's Degree in Criminal Justice or Accounting

Master's Degree in Criminal Justice or Accounting

Tools

MS Word

Excel

Job description

L.A. Care Health Plan seeks a Lead Special Investigations Unit Investigator to oversee investigations, guide provider training communications, and conduct data analysis for fraud detection. The role includes handling investigations, reporting, and referrals to law enforcement.

The position requires at least 5 years in healthcare fraud investigation, advanced analytical ability, and strong communication skills to support complex cases across the organization and with external agencies.