Senior Compliance Investigator University of CaliforniaSenior Compliance InvestigatorLos Angeles, CA$105,700–$234,500 / yearThis role involves gathering and analyzing evidence, conducting interviews, preparing investigative reports, monitoring corrective actions, and partnering with stakeholders to strengthen compliance across the enterprise. As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Senior Compliance Investigator UCLA Health SystemSenior Compliance InvestigatorLos Angeles, CA$105,700–$234,500 / yearThis role involves gathering and analyzing evidence, conducting interviews, preparing investigative reports, monitoring corrective actions, and partnering with stakeholders to strengthen compliance across the enterprise. As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Compliance Investigator(Mountain and West Coast) Acadia Healthcare Co IncCompliance Investigator(Mountain and West Coast)Los Angeles, CAYou will partner with leaders across Compliance, Legal, Human Resources, Clinical Operations, and Quality to evaluate concerns, identify risks, uncover root causes, and help drive meaningful corrective actions that strengthen compliance and protect patients. In this highly visible role, you will conduct and lead investigations involving regulatory compliance, ethics, patient safety, privacy, and healthcare operations across one of the nation''s leading behavioral healthcare organizations.
Senior Compliance Investigator Centene Corporation GroupSenior Compliance InvestigatorCA$70,100–$126,200 / yearLeads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions. Education/Experience: A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
NewCompliance Investigator II Partnership HealthPlan of CaliforniaCompliance Investigator IIFairfield, California$96,970.04–$121,212.56 / yearFull timeBachelor’s degree in relevant field preferred or equivalent combination of education and experience; minimum of two (2) years’ experience as a Regulatory Affairs Specialist or relevant experience in managed care with knowledge of the Medi-Cal, and NCQA requirements, Medicare and Knox Keene. Works directly with DHCS Privacy Office to report privacy related incidents, provide updates upon request, ensure timely filing requirements are met for all reports and follows up on pending cases to confirm cases are closed with the DHCS Privacy Office.
Senior Compliance Analyst and SIU Investigator Community Health GroupSenior Compliance Analyst and SIU InvestigatorChula Vista, CARegulatory Compliance: Ensure all investigations adhere to California Department of Insurance regulations, Centers for Medicare & Medicaid (CMS), Department of Health Care Services (DHCS), and Department of Managed Health Care (DMHC) and other statutory requirements. Under the direction of the CO, timely and comprehensively coordinate, monitor, and perform duties related to CHG's FWA Program, including investigations, CAPs, education and training, and FWA Program development and risk management.
Welfare Fraud Investigator (Entry/Journey) DOQ Solano County CailforniaWelfare Fraud Investigator (Entry/Journey) DOQFairfield, CA$97,136–$138,902.40 / yearThe Welfare Fraud Investigator (Journey) will conduct routine and complex investigations, regarding public assistance eligibility, theft, and fraud, as well as other investigations such as threats against department employees and theft of and damage to public property; prepares cases substantiated for administrative and/or formal legal action; testifies in both judicial and non-judicial proceedings; and performs related duties as required. Note: Incumbents hold peace officer powers pursuant to Section 830.35 of the California Penal Code, however, this is not considered an active law enforcement classification for such personnel administrative matters as retirement, industrial or workers compensation.
NewSupervising Welfare Fraud Investigator (2967) - Investigations Unit- Human Services Agency (167737) City and County of San FranciscoSupervising Welfare Fraud Investigator (2967) - Investigations Unit- Human Services Agency (167737)San Francisco, CA$135,434–$164,580 / yearSelection procedure:After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following:Written Examination: Multiple- Choice (Weight: 100%):Candidates will be administered a written multiple-choice test designed to measure knowledge, skills and/or abilities in job-related areas, which may include oral and written communication, critical thinking, decision making, and leadership. License/Certification: Peace officer statusPossession of or ability to obtain a valid California driver licenseSpecial Requirements:Essential Duties involve the following physical skill and environment:Ability to travel to different sitesRequires eye-hand coordination and manual dexterity for data-entryExtensive VDT exposureApplicants must meet the Minimum Qualification requirement by the final filing date unless otherwise noted.
SIU Clinical Healthcare Fraud Investigator III Mitchell MartinSIU Clinical Healthcare Fraud Investigator IIILos Angeles, CARemote$45–$55.53 / hourBy applying for this job, you agree to receive AI-generated calls, text messages, and/or emails from Mitchell Martin Inc and its affiliates and contracted partners at various frequency through traditional and automated methods. Lead complex investigations into suspected healthcare fraud, waste, and abuse.
SIU Clinical Healthcare Fraud Investigator III (ATL) The Intersect GroupSIU Clinical Healthcare Fraud Investigator III (ATL)Los Angeles, CARemote$45–$55 / hourThe SIU Clinical Healthcare Fraud Investigator III leads complex, high impact investigations into fraud, waste, and abuse across multiple healthcare service lines. The Intersect Group partners with mission focused healthcare organizations dedicated to improving access, quality, and equity of care for large and diverse member populations.
Healthcare Fraud Investigator CONTACT GOVERNMENT SERVICESHealthcare Fraud InvestigatorLos Angeles, CA$85,000–$105,000 / yearCommunication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.
Sr Fraud, Waste and Abuse Investigator (Investigator Sr) CalOptimaSr Fraud, Waste and Abuse Investigator (Investigator Sr)Orange, CA$72,096–$115,353 / yearWe are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr) and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Fraud Investigator/Loss Mitigation Analyst Veros Credit, LLCFraud Investigator/Loss Mitigation AnalystSanta Ana, California$24–$29 / hourFull timeAbout The Position: The Fraud Investigator / Loss Mitigation Analyst is responsible for identifying, investigating, and resolving fraudulent activities and losses related to auto loan originations and servicing across a nationwide portfolio. Analyze auto loan applications, funding packages, and account activity for indicators of fraud, including identity theft, straw purchases, income/occupancy misrepresentation, synthetic identities, and forged documents.
Fraud Investigator - Fully Remote MercorFraud Investigator - Fully RemoteSan Francisco, CaliforniaRemote$60–$70 / hourConstruct enterprise fraud scenarios for large-scale transaction monitoring, multi-stakeholder investigation workflows, and complex regulatory reporting cycles at Fortune 500 institutions. Develop fraud operations scenarios using tools like SAS Fraud Management , Actimize , Feedzai , and enterprise case management/transaction monitoring platforms.
Special Investigation Unit Investigator II (ATL) The Intersect GroupSpecial Investigation Unit Investigator II (ATL)Los Angeles, CARemote$43–$48 / hourThis position plays an important role in identifying risk patterns, supporting enforcement actions, and safeguarding healthcare program integrity through data driven insights and detailed case development. Our client operates one of the largest public health programs in the country, delivering essential services to millions while maintaining a strong focus on compliance, integrity, and accountability.
Investigator, Special Investigative Unit Coding (Remote) Molina Healthcare IncInvestigator, Special Investigative Unit Coding (Remote)CARemoteWorking knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
Special Investigation Unit Investigator III (ATL) The Intersect GroupSpecial Investigation Unit Investigator III (ATL)Los Angeles, CARemote$42–$55 / hourThe Special Investigation Unit Investigator III plays a critical role in protecting healthcare program integrity through the investigation of complex fraud, waste, and abuse cases. You will analyze data, conduct detailed investigations, and collaborate with internal teams and external agencies to identify suspicious activity and support enforcement actions.
INVESTIGATOR State Of CaliforniaINVESTIGATOROrange County, CA$6,339–$10,609 / yearMust be able to work in a law enforcement environment that includes the presence of firearms; Must qualify and carry a firearm; A valid California driver license is required; Must be 21 years of age; Must be able to work both indoors and outdoors, depending on the situation in which investigator is involved, at any given time; There is a reasonable expectation of contact with dangerous suspects; Frequent sitting, standing, walking, and carrying is required; and. Incumbents may work alone, with a team, or as a lead criminal investigator assigned to conduct investigations of criminal enterprises and profiteering and assist in the prosecution of cases involving these groups in both State and Federal courts; and conduct investigations involving a broad range of felony violations, both State and Federal judicial systems.
Fraud Investigator TikTok IncFraud InvestigatorSan Jose, CACollaborate with various levels of the organization internally, including Leadership, Employment Relations, Ethics, Legal Counsel, and DPO as well as with various external organization legal counsel, and law enforcement in fraud and other financial mismanagement cases. Significant experience conducting financial crime investigations, including analyzing large datasets to identify trends and typologies related to financial fraud, money laundering, bribery, and corruption within a large organization.
SIU Investigator Centene Corporation GroupSIU InvestigatorCA$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.