Special Investigations Unit Investigator

🕒 July 2

🌲 Oregon, Washington – Remote

🌲 Oregon – Remote ☕ Washington – Remote

💵 $74.3k - $90.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 38%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

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 fraud, waste, and abuse duties for CareOregon and affiliated lines of business • Develop and operate an effective FWA program in accordance with CMS, OHA/OHP, and applicable legal requirements • Perform routine FWA investigations, audits, and corrective actions • Maintain investigation documents and provide routine updates • Assist senior investigators with complex or advanced investigations • Prepare reports of audit findings and recommend improvements or corrective actions • Prepare, proofread, and distribute confidential correspondence, forms, and specialized information • Respond to routine and ad hoc requests from external regulatory agencies • Prepare reports for internal and external leaders, committees, and governing bodies by collecting, analyzing, and displaying data • Develop and maintain documentation systems for FWA regulatory requirements • Review and recommend FWA/SIU policy and procedure revisions • Attend FWA and compliance-related meetings • Provide FWA training and education to internal and external staff • Educate providers on appropriate documentation and coding • Participate in FWA risk assessment and mitigation processes • Meet departmental key performance indicator metrics • Perform other duties as needed

🎯 Requirements

• Minimum 2 years’ experience in FWA, compliance and/or audit, including in an operational setting within a highly regulated industry • Understanding of healthcare fraud, waste, and abuse • Understanding of the difference between State Medicaid programs and Medicare • Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid • Knowledge of investigative techniques, including interviews, data analytics, evidence gathering, and case documentation • Understanding of information systems • Strong research, investigative, and problem-solving skills • Strong written, verbal, listening, and communication skills • Effective computer skills, including MS Office Suite • Strong interpersonal and motivational skills • Ability to think logically and creatively without undue influence from personal biases • Ability to operate with a high degree of professionalism and confidentiality • Ability to plan, organize, manage, and monitor work projects • Ability to facilitate learning opportunities in informal and formal settings • Ability to make presentations to small and large groups • Ability to bend and speak clearly for at least 3 hours/day • Ability to see, read, and hear for at least 6 hours/day • Ability to perform repetitive finger and wrist movement for at least 3–6 hours/day • Ability to work effectively with diverse individuals and groups

🏖️ Benefits

• Bonus opportunity; 5% annual SIP target • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits, including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits-eligible employees • Remote work from home