SIU Investigator

Kforce Inc.

Los Angeles, CA(remote)

JOB DETAILS
SALARY
$42.73–$55.53
SKILLS
Analysis Skills, Billing, Business Operations, Business Support, Claims Processing, Data Analysis, Documentation, Fraud Investigation, Healthcare, Industry/Trade Press, Legal, Operational Support, Operations Processes, People Management, Process Improvement, Regulations, Regulatory Requirements, Reporting Skills, Request for Information (RFI), Research Skills, Short Messaging Service (SMS), Training Program, Trend Analysis
LOCATION
Los Angeles, CA(remote)
POSTED
1 day ago
Kforce has a client in the Healthcare industry in Los Angeles who is looking for a SIU Investigator. Responsibilities:
  • Reviews allegations and complex issues related to potential healthcare fraud, waste, and abuse involving providers, pharmacies, employers, and members
  • Analyzes claims data, provider information, and other available records to identify unusual billing patterns, trends, and potential areas of concern
  • Conducts research and gathers relevant information from a variety of internal and external sources, including fraud tips, referrals, public records, industry publications, and media reports
  • Documents investigative activities, findings, interviews, and supporting evidence in detailed written reports and summaries
  • Reviews information contained within claims processing systems, provider files, and related databases to identify billing anomalies and potential compliance concerns
  • Participates in onsite reviews, audits, and information-gathering activities as assigned
  • Maintains documentation and case files in accordance with organizational policies, confidentiality requirements, and regulatory guidelines
  • Prepares reports and supporting documentation for internal stakeholders and designated regulatory or compliance teams as appropriate
  • Responds to requests for information and assists with ongoing case tracking and documentation
  • Participates in industry meetings, professional development activities, and training programs to stay informed of emerging fraud trends and investigative techniques
  • Develops and maintains effective working relationships with internal departments, regulatory agencies, and other external stakeholders
  • Applies subject matter expertise to support business operations, process improvement efforts, and investigative reviews
  • Identifies opportunities to enhance workflows, reporting, and analytical processes
  • Provides guidance, knowledge sharing, and training support to team members as needed

Requirements:

  • To be considered for this position, candidates must have experience in a similar role, or they must possess significant knowledge, experience, and abilities to successfully perform the responsibilities listed
  • Relevant education and/or training will be considered a plus

The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.

We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.

Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.

This job is not eligible for bonuses, incentives or commissions.

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

By clicking “Apply Today” you agree to receive calls, AI-generated calls, text messages or emails from Kforce and its affiliates, and service providers. Note that if you choose to communicate with Kforce via text messaging the frequency may vary, and message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You will always have the right to cease communicating via text by using key words such as STOP.


About the Company

K

Kforce Inc.

Kforce is a solutions firm specializing in technology, finance and accounting, and professional staffing services. Our KNOWLEDGEforce® empowers top companies to achieve their digital transformation goals. We curate teams of technical experts who deliver solutions custom-tailored to each client’s needs. These scalable, flexible outcomes are shaped by deep market knowledge, thought leadership and our multi-industry expertise.

 

Our integrated approach is rooted in 60 years of proven success deploying highly skilled professionals on a temporary and direct-hire basis. Each year, approximately 18,000 talented experts work with the Fortune 500 and other leading companies. Together, we deliver Great Results Through Strategic Partnership and Knowledge Sharing®.

COMPANY SIZE
1,000 to 1,499 employees
INDUSTRY
Financial Services
FOUNDED
1962
WEBSITE
http://www.kforce.com/