Senior Investigator, Investigations Unit

🕒 July 2

🌲 Oregon, Washington – Remote

🌲 Oregon – Remote ☕ Washington – Remote

💵 $92.1k - $112.5k / year

⏰ Full Time

🟠 Senior

✨ Investigator

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Administer the fraud, waste, and abuse (FWA) duties at an advanced level • Ensure effective measures are in place and operating effectively to prevent, detect, and correct fraud, waste, and abuse • Perform advanced level of fraud investigations and provide regular FWA reporting to regulatory agencies • Help ensure that appropriate procedures are in place and followed consistently to safeguard assets, verify accuracy and reliability of data, and promote efficient operations • Contribute to the development and operation of an effective FWA program in accordance with CMS requirements and Federal Sentencing Guidelines • Prepare reports of audit findings and recommendations • Educate and coach leaders and staff regarding FWA requirements and complex issues • Participate in completing required Medicare and Medicaid filings and/or responses for FWA

🎯 Requirements

• Minimum 5 years’ experience in compliance and/or audit • Minimum 1 year experience focused on fraud, waste, and abuse • CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner) Preferred • Fraud, waste and abuse experience in Medicaid or Medicare

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • Life insurance • AD&D insurance • Disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.) • Strong retirement plan with employer contributions • Paid time off (PTO) • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty • Bereavement leave