PacificSource

PacificSource

Senior Investigator

Bend, OR · Senior

Sponsorship not specified$65k-$111kDetected 7 days ago
ComplianceAuditingHIPAAResearchCommunicationCollaborationProblem SolvingAdaptabilityOrganizational SkillsMicrosoft Office

About the role

  • Looking for a way to make an impact and help people?
  • Join PacificSource and help our members access quality, affordable care!
  • PacificSource is an equal opportunity employer.

Responsibilities

  • Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures.
  • Develop and conduct internal FWA related training.
  • Collaborate with government agencies during audits, investigations and Requests for Information (RFI).
  • Coordinate and manage the production of investigative materials in support of, settlement negotiations.
  • Establish and maintain a comprehensive knowledge and understanding of current state and federal reporting requirements ensuring FWA reporting is received, summarized, catalogued, and disseminated to the appropriate agencies.
  • Perform other duties as assigned.
  • Maintain sufficient reference materials to adequately research compliance issues.
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust

Requirements

  • Ability to read and comprehend both written and spoken English.
  • It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
  • Ability to obtain Certified Fraud Examiner (CFE) or equivalent certification within 24 months of employment required.
  • Travel is required approximately 10% of the time.
  • Computer proficiency in a Windows environment, including Microsoft Office Suite.

Nice to have

  • Significant experience in facilitating audit activities across specialized teams required.
  • Ability to effectively and professionally communicate with internal and external stakeholders, in both written and verbal form, required.
  • Experience in navigating case management, claims and OSINT platforms preferred.

Skills

  • Compensation Disclaimer
  • Base Range:
  • $65,296.83 - $111,004.62
  • The wage range provided reflects the full range for this position.
  • Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.

Compensation

  • The wage range provided reflects the full range for this position.
  • The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage.
  • Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
  • Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Benefits

  • Strong working knowledge of investigative techniques and procedures as they relate to health care fraud, waste and abuse is required.
  • Working knowledge of legal and medical terminology.

Company info

  • We are committed to doing the right thing.
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This listing is sourced directly from PacificSource's careers page and normalized into a canonical job model.