PacificSource
Senior Fraud, Waste and Abuse (FWA) Specialist
Boise, ID · Senior
Sponsorship not specified$65k-$111kDetected 1 day ago
ComplianceAuditingHIPAALeadershipCommunicationCollaborationProblem SolvingPublic SpeakingAdaptabilityOrganizational SkillsClaims Management
> stay_score
odds of building a lasting career here
26Unrated
Cap-exempt (no lottery)0
Sponsors this role0
Entry-level history0
PERM / green-card track0
Lottery odds (Level II)66
Fits your clock70
No strong sponsorship signal in the public record yet. In the full product we resolve the exact legal entity and show its filing history with a confidence score — treat as unverified until then.
Lottery odds assume a STEM candidate.
Personalize to your clock →> community_outcomes
No reports yet — be the first to help the next applicant.
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
- Support the development and maintenance of the Payment Integrity and FWA program framework.
- Develop, implement, and maintain program policies, workflows, procedures, and controls.
- Maintain centralized tracking and reporting systems for investigations, recoveries, referrals, and regulatory activities.
- Support internal and external audits and corrective action initiatives.
- Collaborate with analytics teams to develop prospective and retrospective monitoring strategies.
- Develop recommendations to improve program effectiveness and financial recoveries.
- Develop and deliver FWA training and awareness programs.
- Perform day-to-day tasks of the compliance department as needed.
- Perform other duties as assigned.
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.
- Experience with data mining, analytics, regulatory reporting, or collaboration with investigative teams is highly desirable.
- Candidates with an associate's degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
Nice to have
- Experience working with Medicare and/or Medicaid programs 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
- Coordinate annual audit, monitoring, and work plan activities.
Benefits
- Minimum of 5 years of experience in fraud, waste, and abuse (FWA), payment integrity, healthcare compliance, claims auditing, claims analysis, or related healthcare operations functions.
- Experience analyzing healthcare claims data, identifying potential payment integrity risks, and supporting FWA monitoring, reporting, or compliance activities required.
- Education, Certificates, Licenses:
- Bachelor's degree in business, management, health care administration or related field required.
- Working knowledge of fraud, waste, and abuse (FWA) concepts, payment integrity practices, healthcare claims processing, and Medicare and Medicaid requirements.
Company info
- Base Range: $65,296.83 - $111,004.62 Our Values We live and breathe our values.
Apply directly at PacificSource →Create a free account for alerts like thisView PacificSource immigration profile
This listing is sourced directly from PacificSource's careers page and normalized into a canonical job model.