PERMANENT

FULL_TIME

YEAR

Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc. **Minimum of 3 years of experience in healthcare fraud investigation/detection **Healthcare-related specialty, including but not limited to: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental, etc.

Job Title:Special Investigation Unit Investigator IILocation:   Los Angeles, CA Job descriptionThe Special Investigation Unit Investigator II is the journeyman level Investigator position for the Special Investigations Unit (SIU). This position conducts complex independent investigations of alleged fraudulent billing and other suspected fraudulent activities related to client, members and providers. The position works closely with the department heads on potential fraud, waste and abuse areas. This position ensures investigations are conducted objectively and are lawfully compliant. The Investigator II thoroughly gathers all material facts and presents an accurate and objective accounting of the issues.Duties<ul><li>Conducts complex independent investigations resulting from the discovery of suspicious claims or incidents involving client, members and service providers that could potentially involve fraud, waste, or abuse. Reviews information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action. Participates in onsite audits as assigned in conjunction with investigation development.  Completes investigation after referrals to law enforcement (Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) or local police).  Participates at hearings/appeals and can testify as a witness in court proceedings.  Initiates the process with client’s Recovery Services for recoupment of overpaid monies.</li><li>Submits referrals of suspected fraud cases within mandated period of time as required by DHCS and CMS. Prepares and submits investigative report documenting all phases of an investigation. Compiles and maintains various documentation and other reporting requirements. Maintains chain of custody on all documents and follows all confidentiality and security guidelines. Maintains cases referred to law enforcement and responds to requests for information; pursues applicable administrative actions during investigation/case development.</li><li>Utilizes data analysis techniques to detect unusual billing claims data, and proactively seeks out and develops leads received from fraud tips and any variety of sources (e.g., fraud alerts, media).</li><li>Participates in industry meetings/trainings and is able to effectively share and gather significant information. Able to liaison with industry peers and where necessary, interface appropriately with law enforcement. Continually enhances investigative skills and understanding of emerging issues and trends impacting the industry.</li></ul>Perform other duties as assigned.<ul><li>Duties Continued</li><li>Education Required</li><li>Bachelor's Degree in Criminal Justice or Related Field</li><li>In lieu of degree, equivalent education and/or experience may be considered.</li></ul>Education Preferred<ul><li>Master's Degree in Criminal Justice or Related Field Experience</li></ul>Required:<ul><li>Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.</li></ul>Preferred:  Demonstrated investigative and/or health care expertise.  Experienced in reviewing, analyzing/developing information to include interviewing, report writing and decision making.  SkillsRequired:<ul><li>Excellent research skills and the ability to support conclusions with documentary evidence.</li><li>Demonstrated strong organizational skills and the ability to manage multiple demands and priorities.</li><li>Excellent and effective communication skills, both verbal and written.</li><li>Proficient computer skills, including computer applications such as MS Word and Excel. </li><li>Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.</li><li>Licenses/Certifications Required</li><li>Licenses/Certifications Preferred</li><li>Certified Fraud Examiner (CFE)</li><li>Accredited Health Care Fraud Investigator (AHFI)</li><li>Certified Professional Coder (CPC) designation by the American Academy of Professional Coders</li></ul> Must-haves<ul><li>**Minimum of 3 years of experience in healthcare fraud investigation/detection **Healthcare-related specialty, including but not limited to: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental, etc. Ideally, in Managed Care **Experience with managing high-volume case load with experience drafting executive summaries</li></ul>Less Common Requirements<ul><li>Master Degree</li></ul>Required Skills<ul><li>**Minimum of 3 years of experience in healthcare fraud investigation/detection **Healthcare-related specialty, including but not limited to: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental, etc. Ideally, in Managed Care **Experience with managing high-volume case load with experience drafting executive summaries</li></ul>Preferred or Nice-to-have Skills<ul><li>Preferred working in a Managed Care setting Master’s Degree</li></ul>

INFT Solutions, Inc

Special Investigations Unit (SIU) Investigator – Healthcare Fraud

Accounting

Behavioral Health

Billing

Centers for Medicare and Medicaid Services (CMS)

Certified Financial Examiner (CFE)

Certified Professional Coder (CPC)

Claims Processing

Communication Skills

Computer Security

Computer Skills

Criminal Justice

Data Analysis

Documentaries

Durable Medical Equipment

Fraud Investigation

Health Department

Healthcare

Home Care

Hospice Care

Law Enforcement

Lead Generation

Legal

Managed Care

Medi-Cal

Medicare

Microsoft Excel

Microsoft Word

Multitasking

Organizational Skills

Pharmacy

Presentation/Verbal Skills

Psychiatry and Mental Health

Reporting Skills

Request for Information (RFI)

Research Skills

Trend Analysis

United States Department of Justice (DOJ)

Writing Skills

monster

UNKNOWN

FEED

The Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. Conduct independent investigations of insurance claims across a range of coverage types, including workers' compensation, general liability, property and casualty, and disability.

HOUR

Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.Allied Universal® is hiring a Surveillance Investigator. The Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. <ul><li>Pay Rate: $20 - $24 / hr </li></ul><ul><li>Company credit card to cover fuel and travel expenses </li></ul><ul><li>Must possess a valid driver's license with at least one year of driving experience </li></ul> RESPONSIBILITIES:<ul><li>Conduct independent investigations of insurance claims across a range of coverage types, including workers' compensation, general liability, property and casualty, and disability</li><li>Utilize various surveillance techniques and equipment to monitor subjects covertly</li><li>Document and report observations, activities, and any relevant information in a clear and concise manner</li><li>Collaborate with other investigators and law enforcement agencies as needed to gather information and coordinate efforts</li><li>Maintain confidentiality and adhere to legal and ethical standards in conducting surveillance operations</li></ul>QUALIFICATIONS (MUST HAVE):<ul><li>High school diploma or equivalent</li><li>Post offer, must be able to successfully complete the Allied Universal Investigations' training/orientation course</li><li>Minimum of one (1) year of verifiable work experience, preferably involving investigations or other protective service-related field</li><li>Flexibility to work varied and irregular hours/days including weekends and holidays</li><li>Ability to type reports in Microsoft Word format with minimal grammatical and punctuation errors</li><li>Proficient in utilizing laptop computers, video cameras and cell phones</li><li>Capable of maintaining focus and multitasking effectively in a dynamic environment</li><li>Demonstrated ability to manage stressful situations with composure and professionalism</li><li>Ability to work in a very independent environment</li></ul>PREFERRED QUALIFICATIONS (NICE TO HAVE):<ul><li>Associate's Degree or higher, preferably in Criminal Justice</li><li>Security/Loss Prevention experience</li><li>Military experience</li><li>Law enforcement experience</li><li>Prior insurance investigations experience</li><li>Prior educational or professional incident reporting and/or investigations experience</li></ul>BENEFITS:<ul><li>Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance</li><li>Seven paid holidays annually, sick days available where required by law</li><li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul>Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: <a href="https://www.aus.com/" rel="noopener nofollow noreferrer" style="color:#0000ff" target="_blank">www.aus.com</a>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: <a href="https://www.aus.com/offices" rel="noopener nofollow noreferrer" style="color:#0000ff" target="_blank">www.aus.com/offices</a>..

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>

Allied Universal

Surveillance Investigator

Accidental Death and Dismemberment (AD&D)

Cellular Telephone

Credit Cards

Data Collection

Disability Insurance

Driver's License

High School Diploma

Insurance

Insurance Claims

Laptop PC

Legal Standards

Loss Prevention

Military

Protective Services

Surveillance

Worker's Compensation

TMP_Allied Universal Feed

Homeboy Industries is the largest gang rehabilitation and re-entry program in the world, providing hope, training, and support to formerly gang-involved and previously incarcerated people, allowing them to redirect their lives and become contributing members of our community. The GAO will write and submit public grant proposals, monitor compliance and reporting requirements, build relationships with key stakeholders to represent Homeboy Industries in grantor monitoring meetings and trainings.

About the Organization Homeboy Industries is the largest gang rehabilitation and re-entry program in the world, providing hope, training, and support to formerly gang-involved and previously incarcerated people, allowing them to redirect their lives and become contributing members of our community. Through therapeutic and educational offerings, practical services, and a roster of social enterprises, Homeboy fosters healing and builds self-sufficiency while addressing the root causes of poverty and incarceration.<div align="center" style="text-align:center"><hr align="center"/></div>Position Summary The Government Affairs Officer (GAO) is responsible for securing and managing government funding opportunities. This role combines grant development, reporting, relationship management, and advocacy to strengthen the organization’s impact and sustainability. The GAO will write and submit public grant proposals, monitor compliance and reporting requirements, build relationships with key stakeholders to represent Homeboy Industries in grantor monitoring meetings and trainings.<div align="center" style="text-align:center"><hr align="center"/></div>Essential Responsibilities for Impact Grant Writing & Reporting<ul><li>Prepare high-quality government grant proposals, contracts, and related materials.</li><li>Develop and submit timely grant reports, ensuring accuracy and alignment with funder requirements.</li></ul>Compliance & Monitoring<ul><li>Support program teams in meeting compliance standards for government grants and contracts.</li><li>Monitor reporting deadlines, deliverables, and site visits to ensure adherence to all requirements.</li></ul>Relationship Building & Advocacy<ul><li>Build and maintain relationships with city, county, state, and federal stakeholders.</li><li>Support in representing Homeboy Industries in advocacy coalitions, and stakeholder meetings.</li><li>Assist in preparing testimony, policy briefs, and position statements that advance Homeboy’s mission.</li></ul><div align="center" style="text-align:center"><hr align="center"/></div>Additional Impact Areas<ul><li>Collaborate with the team to highlight government partnerships and advocacy successes.</li><li>Stay current on trends in public funding, criminal justice reform, and Reentry.</li><li>Contribute to strategies that increase Homeboy Industries’ visibility as a leader in criminal justice reform.</li></ul><div align="center" style="text-align:center"><hr align="center"/></div>Education and Experience Required<ul><li>Minimum of 5 yrs of experience in government relations, fundraising or grant writing/administration.</li><li>Proven track record in preparing successful government grant proposals and managing reporting/compliance.</li><li>Strong understanding of legislative and public funding processes at the city, county, state, and federal levels.</li><li>Bachelor’s degree in Public Policy, Political Science, or related field preferred.</li></ul><div align="center" style="text-align:center"><hr align="center"/></div>Skills and Competencies<ul><li>Excellent writing, editing, and research skills with attention to detail.</li><li>Strong political acumen and ability to build relationships across sectors.</li><li>Ability to manage multiple deadlines, proposals, and advocacy initiatives simultaneously.</li><li>Deep alignment with Homeboy Industries’ mission and a passion for social justice.</li><li style="text-align:center"><hr align="center"/></li></ul>Homeboy Industries is an equal opportunity employer and welcomes applicants from all backgrounds and experiences. Pay Range: 65k - 85k per annum depending on experiencePowered by JazzHR

Homeboy Industries

Government Affairs Grant Officer

Detail Oriented

Editing

Funding

Fundraising

Government

Government Contracts

Government Funding

Government Grants

Government Relations

Grant Administration/Management

Grant Writing

Maintain Compliance

Political Science

Position Statements

Public Policy

Regulatory Compliance

Relationship Management

Sales Management

Sustainability

Time Management

Training/Teaching

partner JazzHR

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Special Investigations Unit (SIU) Investigator – Healthcare FraudINFT Solutions, Inc

Surveillance InvestigatorAllied Universal

Government Affairs Grant OfficerHomeboy Industries

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