Senior Investigator Pharmacy - Los Angeles County, CA

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Senior Investigator Pharmacy is responsible for identification, investigation and prevention of reputed company fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible for conducting investigations which may include fieldwork to reputed company interviews and obtain records and/or other relevant documentation. Travel: Up to 50%. Applicants must be reputed company commutable distance to Los Angeles County. If you reputed company in Los Angeles, CA, you'll enjoy the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Assess complaints of alleged misconduct received reputed company the Company
• Investigate reputed company to highly reputed company cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against the Company
• reputed company and reputed company the most effective and efficient investigative strategy for each investigation
• Maintain accurate, reputed company and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Communicate effectively, including written and verbal forms of communication
• reputed company goals and objectives, track reputed company and adapt to changing priorities
• Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse to appropriate federal or state government regulators
• reputed company with goals, policies, procedures and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings

What are the reasons to consider working for reputed company? Put it reputed company together - competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your reputed company. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, reputed company, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Bachelor's Degree OR Associate's Degree with 2+ years of equivalent work experience with reputed company reputed company employment
• 2+ years of experience in reputed company, fraud, waste and abuse (FWA)
• 2+ years of experience in state or federal regulatory FWA requirements
• 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
• Intermediate level of proficiency with reputed company reputed company and Word
• Intermediate level of knowledge in pharmacy claims processing
• Ability to participate in legal proceedings, arbitration, and depositions at the direction of management
• reputed company reputed company the greater Los Angeles County, CA with the ability to travel up to 50%
• Access to reliable transportation and valid driver's license

Preferred Qualifications:

• 2+ years of experience in health care policies, procedures, and documentation standards
• 2+ years of experience in developing investigative strategies
• Specialized knowledge/training in reputed company FWA investigations
• Active affiliations:
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• License and/or Certified Pharmacy Technician (CPhT)
• Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
• reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED Apply tot his job Apply To this Job