CareOregon
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.
Senior Investigator, Investigations Unit
🔥 0 minutes ago
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
CareOregon
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
Apply NowSimilar Jobs
🔥 2 hours ago
Senior Investigator conducting investigations of healthcare fraud and abuse at CVS Health. Handling high-profile cases and collaborating with law enforcement as needed.
🕒 Yesterday
Field Investigator II conducting property insurance fraud investigations with up to 70% travel. Coordinating with law enforcement and maintaining industry contacts for comprehensive fraud investigation.
🕒 Yesterday
Account Investigator in Refunds team analyzing patient accounts for healthcare billing. Collaborating with a remote team to resolve credit balances efficiently.
🕒 2 days ago
Senior Investigator leading complex OSINT investigations to protect intellectual property rights. Collaborating with global teams in the Special Investigations Unit to combat infringement worldwide.
🕒 2 days ago
Threat Investigator at 10a Labs, responsible for detecting abuse activities and supporting investigations. Working in sensitive areas requiring strong technical skills in SQL and Python alongside on-call responsibilities.
