Special Investigations Unit Specialist

Special Investigations Unit Specialist

Rancho Cucamonga, CA

Temporary position

$24.50-$27.00/hourly

The Special Investigations Unit (SIU) Specialist is responsible for the intake, initial assessment and coordination of Fraud, Waste, and Abuse (FWA) referrals within the SIU. This role plays a critical part in the early stages of case management, including the documentation, initial analysis, and prioritization of FWA issues according to risk and potential impact. The Specialist organizes, analyzes, and reports referral data, and utilizes the Plan’s case management application and FWA analytics tools to support the SIU in proactive FWA detection.

Responsibilities:

Qualifications:

Education & Requirements 

• Minimum of three (3) years of experience in a healthcare environment
• Experience preferably in managed care
• Strong preference for experience in fraud investigations or compliance
• High School diploma or GED required
• Associate degree or bachelor’s degree from an accredited institution preferred
• Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred

Key Qualifications

• Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
• Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.) as tested by IEHP
• Intermediate to advanced proficiency in Microsoft Excel is required
• Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms is highly desirable
• Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
• Excellent interpersonal skills. Effective communication skills; verbal and written.
• Strong analytical skills
• Proven ability to work independently and as part of a team in a high-stakes environment
• Ability to manage multiple cases and projects with competing deadlines
• Excellent interpersonal and communication skills, capable of working effectively across various departments and with external partners
• Detail-oriented
• Strong commitment to integrity and ethical decision-making

Apply: jmstaffing.com

JM Temporary Services & Affiliates, Inc., dba JM Staffing, JM Medi-Stat is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.