Molina Healthcare
Investigator, Special Investigative Unit (Remote)
TX, United States
Sponsorship not specifiedDetected 2 days ago
Data AnalysisCustomer SupportResearchCommunicationProblem SolvingMicrosoft Office
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odds of building a lasting career here
31Risky
Cap-exempt (no lottery)0
Sponsors this role58
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70
Thin sponsorship signal and lottery-bound. A low-probability bet with your clock running. Prioritize cap-exempt roles and proven entry-level sponsors first.
Lottery odds assume a STEM candidate.
Personalize to your clock →Employer immigration record
from this employer's Department of Labor filings
Green-card filing pattern in this occupation
Context, not a finding about this posting: of this employer's 7 green-card filings in this occupation, 100% were for a worker who already held the job.
Green-card follow-through: 40%
Of 5 labor certifications old enough to have been used, 3 expired without the employer filing the next step. Median time from filing to decision: 500 days.100% of their filings were for a worker who already held the job.Only certifications past the 180-day window are counted — recent ones cannot have expired yet.
Files H-1B transfers
2 transfer filings in the last year, covering 2 workers. Median labor-condition decision: 8 days. An employer that already files transfers is one that can take over an existing H-1B.
Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.
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About the role
- Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA).
- Conducts both on-site and desktop investigations.
- Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential FWA.
Responsibilities
- Provides investigative support for special investigation unit (SIU) activities.
- Responsible for developing leads presented to the special investigation unit (SIU) to assess and determine whether potential fraud, waste, or abuse (FWA) is corroborated by evidence.
- Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements.
Requirements
- Proven investigatory skills including ability to organize, analyze, and effectively determine risk with corresponding solutions, and remain objective and separate facts from opinions.
- Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
- Knowledge of managed care and Medicaid, Medicare, and Marketplace programs.
- Ability to research and interpret regulatory requirements.
- ability to interact with individuals at all levels.
- Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations.
- Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when FWA is identified as required by regulatory and/or contract requirements.
Nice to have
- Experience in government programs (i.e., Medicare, Medicaid, Marketplace).
- Experience in FWA or related work.
- To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Compensation
- Molina Healthcare offers a competitive benefits and compensation package.
Benefits
- Performs accurate and reliable medical review audits that may also include coding and billing reviews.
- Coordinates with various internal customers (e.g., provider services, contracting and credentialing, healthcare services, member services, claims, etc.), to gather documentation pertinent to investigations.
- Detects potential health care FWA through the identification of aberrant coding and/or billing patterns through utilization review.
- Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.
- May work with other internal departments, including compliance, corporate legal counsel, and medical affairs to achieve and maintain appropriate anti-fraud oversight.
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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.