Program Integrity Investigator — Fraud & Audit Expert

sfhp; San Francisco (CA); Hybrid; USD 100,000 - 115,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Paid time off

Tuition reimbursement

Job summary

San Francisco Health Plan (SFHP) invites applications for an Investigator, Program Integrity. The role conducts investigations, audits, and monitoring to strengthen SFHP's internal controls and mitigate compliance risk.

You will manage a caseload, prepare professional reports, and coordinate with internal and external partners to drive timely conclusions. The hybrid position requires onsite presence in Downtown San Francisco a minimum of 4 days per month, with a focus on rigorous data analysis

Qualifications

• Bachelor's degree or equivalent experience required.
• Minimum of five years in healthcare industry and operations.
• Certifications such as CPC/AHFI/CIA preferred.

Responsibilities

• Conduct objective investigations into fraud, waste or abuse.
• Manage caseload and provide management reports.
• Review evidence and synthesize data into findings.
• Document investigative steps in formal reports.
• Communicate progress and findings to stakeholders.
• Ensure regulatory compliance and strengthen controls.
• Assist with annual workplan and program integrity framework.
• Coordinate external audits and support corrective actions.
• Support HIPAA compliance investigations.

Skills

Investigation

Auditing

Data analysis

Reporting

Compliance

Education

Bachelor's degree in business administration or related field

Job description

San Francisco Health Plan (SFHP) invites applications for an Investigator, Program Integrity. The role conducts investigations, audits, and monitoring to strengthen SFHP's internal controls and mitigate compliance risk.

You will manage a caseload, prepare professional reports, and coordinate with internal and external partners to drive timely conclusions. The hybrid position requires onsite presence in Downtown San Francisco a minimum of 4 days per month, with a focus on rigorous data analysis