Role: Special Investigation Unit Investigator III
Duration: Contract
Hours: Mon - Fri 8a - 5p West-Coast hours
Location: 100% remote
Pay: $40 - $50/hour
About the Role
Join the nation’s largest publicly operated health plan to lead complex healthcare fraud, waste, and abuse investigations across Medi?Cal and Medicare. This senior SIU role handles high?impact cases and serves as a subject matter expert, mentor, and audit lead.
What You’ll Do
Lead end?to?end investigations of suspected provider, member, and pharmacy fraud
Analyze claims data, billing patterns, and fraud leads to identify irregularities
Develop investigative strategies and produce clear, defensible reports
Partner with agencies (DHCS, CMS, DOJ, law enforcement) and support referrals
Lead onsite audits, testify when needed, and support recovery efforts
Mentor junior investigators and provide training on investigative best practices
Key Details
Caseload: ~75–85 active cases (transportation, pharmacy; no dental/hospital)
Focus: Primarily Los Angeles County/California
Training: Structured 2?week onboarding + ongoing development
Goal: ~100?day case resolution depending on complexity
Fast start: onboarding within ~3–5 days of offer
What You Bring
5+ years in healthcare fraud investigation or related specialty
Strong clinical/claims review and data analysis skills (Excel required)
Experience with interviews, evidence development, and case reporting
Knowledge of CMS/Medicare/Medi?Cal guidelines preferred
Preferred
Certifications: CFE, AHFI, CPC
Experience across multiple specialties (Pharmacy, DME, Behavioral Health, etc.)
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