CrawlJobs Logo
L.A. Care Health Plan Logo L.A. Care Health Plan · Finance

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

United States, Los Angeles 135136.00 - 216218.00 USD / Year · Job Posted January 01, 2026

Job offer has expired

Job Link Share

Job Description

The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan’s enterprise special investigations unit (SIU) and FWA program. The Director oversees internal and external investigations into potential misconduct, regulatory violations, and fraudulent activity while ensuring compliance with federal and state regulatory requirements.

Job Responsibility

  • Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing internal and external investigations into fraud, waste, abuse, and compliance violations
  • Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program
  • Ensure effective case intake, triage, investigation, tracking, and resolution processes
  • Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response
  • Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior
  • Partner with Legal, Compliance, and Human Resources on sensitive internal investigations
  • Ensure timely and accurate reporting of SIU/FWA activity to external agencies
  • Lead enterprise readiness for external audits, regulatory inquiries, and enforcement actions
  • Conduct strategic planning to use resources to meet departmental and Enterprise-wide goals
  • Monitor investigative trends, emerging risks, and regulatory developments
  • Develop dashboards, analytics, and reporting tools
  • Serve as a trusted advisor and subject matter expert to senior leadership
  • Collaborate with cross-functional leaders to embed FWA prevention and detection mechanisms
  • Champion a culture of integrity, accountability, and transparency
  • Develops goals, objectives and actions plans for assigned staff
  • Manages budgets and resources effectively

Requirements

  • Bachelor's Degree in Criminal Justice or Related Field
  • At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field
  • At least 5 years of experience in leading teams, projects, initiatives, or cross-functional groups
  • Demonstrated experience managing complex investigations in a managed care or healthcare environment
  • Experience in coordinating with external regulators and law enforcement agencies
  • Proven knowledge of CMS, DHCS, DMHC, OIG, and DOJ regulatory frameworks governing FWA programs
  • Strong investigative skills, including evidence gathering, interviewing, and case documentation
  • Demonstrated success in leading complex, multi-party investigations with integrity and discretion
  • Excellent communication skills
  • Strong organizational and project management abilities
  • Executive presence with ability to influence and build trust across the enterprise
  • Demonstrated ability to think long-term and develop strategies
  • Certified Fraud Examiner (CFE) or Certified HealthCare Compliance (CHC) or Certified Internal Auditor (CIA) or Certified Coder, RN, MD, PharmaD, or equivalent

Nice to have

  • Master's Degree in Public Policy or Related Field
  • Prior leadership of a Special Investigations Unit (SIU) or equivalent function in a health plan, government agency, or large healthcare system
  • Experience with compliance technology platforms and advanced data analytics for FWA detection
  • Bilingual in one of L.A. Care Health Plan’s threshold languages (English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese)

What we offer

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
L.A. Care Health Plan - All Job Offers

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Suggested Tags: Frontend Developer Secretary Talent Manager Salesforce Administrator Data Analyst
Similar Jobs for

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

8 matching positions

Director, Fraud Prevention and Program Oversight

Community First Health Plans, Inc. (Community First) is an HMO providing health ...
Location
Location
United States , San Antonio
Salary
Salary:
40.87 - 91.35 USD / Hour
universityhealth.com Logo
University Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree is required in accounting, business administration or related field
  • Experience in interpretation of regulatory agency policies is preferred
  • Experience with anti-fraud detection and prevention is required
  • Three years of supervisory experience is preferred
  • Experience with SEC SOX and/or NAIC MAR audits, and Enterprise Risk Management (ERM) is highly desirable
  • At least three years of professional audit experience is required
Job Responsibility
Job Responsibility
  • Leads the organization’s efforts to prevent, detect, investigate, and remediate fraud, waste, and abuse (FWA) across all product lines
  • Ensures program integrity by setting organizational standards, strengthening internal controls, and overseeing the Special Investigations Unit (SIU) operations, payment integrity analytics, and vendor oversight
  • Ensures program integrity by setting enterprise standards, strengthening internal controls, and overseeing SIU operations, payment integrity analytics, vendor oversight, and internal auditing functions
  • Fulltime
Read More
Arrow Right

Director, Payment Integrity

The Director, Payment Integrity provides strategic leadership and oversight for ...
Location
Location
United States , Phoenix
Salary
Salary:
Not provided
azblue.com Logo
Blue Cross Blue Shield of Arizona
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 10 years of experience in Payment Integrity, Special Investigation Unit, or healthcare anti-fraud
  • 7+ years of experience in management role
  • 2+ years of experience in Vendor Partner Oversight
  • contracting and vendor management of external payment vendors and/or audit firms
  • Demonstrated success in developing and executing enterprise-wide strategies
  • Bachelor's Degree in business, statistics, healthcare administration or related field of study
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment
  • Basic skill in word processing and presentation software
  • Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software
Job Responsibility
Job Responsibility
  • Develop and execute enterprise-wide Payment Integrity strategy aligned with organizational objectives and cost of care targets
  • Lead the design, implementation, and continuous improvement of payment integrity programs, including pre- and post-payment audits, recovery, and investigative functions
  • Establish and maintain governance structures, including cross-functional committees, to oversee payment integrity controls and policy development
  • Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation
  • Stay abreast of emerging trends, technologies, and regulatory shifts in the healthcare payment integrity space
  • Oversee day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities
  • Direct vendor management, including contracting, performance oversight, and strategic partnerships for payment integrity solutions
  • Drive automation and technology adoption to enhance payment integrity processes and reporting capabilities
  • Lead cost-benefit analyses to determine optimal resource allocation (internal vs. outsourced functions)
  • Set and monitor KPIs, SMART goals, and financial targets for payment integrity initiatives
  • Fulltime
Read More
Arrow Right
New

Vice President

iCapital is looking to hire an investment product specialist Vice President to s...
Location
Location
China , Hong Kong
Salary
Salary:
Not provided
icapital.com Logo
iCapital Network
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 10+ years of experience working within the alternative investment industry in a client facing capacity (e.g., Investor relations at GPs or distribution specialist at placement agents, fund of funds and asset management firms with alternative investment product experience)
  • A self-starter who demonstrates the ability to work in a fast-paced entrepreneurial environment and follow a rigorous sales process
  • Strong team orientation with exceptional organizational and interpersonal skills especially in a cross-boarder and small team-working environment
  • Strong with Microsoft powerpoint and has excellent verbal and written communication skills
  • Local regulatory licensing is required
  • Relevant language skills is a plus
Job Responsibility
Job Responsibility
  • Leverage a consultative sales process to acquire new relationships, expand existing client relationships, and service assets under management
  • Develop high level of sales proficiency with iDirect offerings in private equity, private credit, and hedge funds and other future iDirect products and a good understanding of the asset class as well as product comparison purposes
  • Traveling is required to markets to meet with gatekeepers, advisors, industry bodies, end clients in support of the broader sales and educational effort
  • Assist in the planning and execution of roadshows and conferences
  • Work alongside the in region Client Solutions team personnel on client pitches, product positioning, and sales campaigns
  • Leverage technology input and reporting tools to support sales management activities
  • Fulltime
Read More
Arrow Right

Customer Assistant II

Location
Location
United States , Amherst
Salary
Salary:
26.06 - 29.33 USD / Hour
mma.org Logo
Massachusetts Municipal Association
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High school degree or equivalent PLUS one to three years of experience in accounting, bookkeeping, or cash handling
  • OR any equivalent combination of related education and experience that demonstrates the ability to successfully perform the responsibilities of the position
Job Responsibility
Job Responsibility
  • Perform a full range of complex procedural accounting and clerical duties associated with computation, reconciliation and posting to accounts for town collection areas (e.g., Water and Sewer, Parking)
  • Fulltime
Read More
Arrow Right

Care Assistant - Days

Are you ambitious? Do you want something else? Are you looking for new energy? W...
Location
Location
United Kingdom , Poynton
Salary
Salary:
12.75 GBP / Hour
jobs.360resourcing.co.uk Logo
360 Resourcing Solutions
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • No previous experience or qualifications needed
  • Enhanced DBS check in relation to Children and Adults required
Job Responsibility
Job Responsibility
  • Support with personal care needs
  • Help residents take part in a wide range of special interests and activities that support their health and wellbeing such as arts and crafts, watching the footie, drama, musical evenings, gardening, shopping trips and social occasions
What we offer
What we offer
  • Discounts on Shopping, Fashion, Days out, Travel, Entertainment and lots more
  • Flex Earn – Earned wage access
  • FREE face-to-face counselling for you and your family
  • Staff recognition award ceremonies
  • £30 voucher available every month for the nominated Employee of the month
  • Opportunities for training and career progression
  • Salary Sacrifice Pension scheme
  • Blue Light Card – up to 50% discount across 100’s of retailers
  • Access to a FREE eye test and discounted glasses
  • Cashback card – save up to £500 annually
  • Fulltime
Read More
Arrow Right

DPW Highway Equipment Operator

The town of Littleton is seeking qualified applicants for a full-time 40-hour/we...
Location
Location
United States , Littleton
Salary
Salary:
24.56 - 29.54 USD / Hour
mma.org Logo
Massachusetts Municipal Association
Expiration Date
July 17, 2026
Flip Icon
Requirements
Requirements
  • Valid driver's license
  • CDL class B
  • Hoisting license 2B/1C minimum (or ability to obtain within 12 months)
  • Ability to operate heavy equipment, riding mowers, snow and ice equipment, power and hand tools
  • Snow and ice operations, drainage system experience and roadway construction knowledge preferred
Job Responsibility
Job Responsibility
  • Perform routine work assisting in all Public Works construction, maintenance and repair projects
  • Operate heavy equipment, riding mowers, snow and ice equipment, power and hand tools
What we offer
What we offer
  • On call standby stipend
  • Winter standby stipend
  • Licenses and clothing stipends per union contract
  • Overtime available
  • Fulltime
!
Read More
Arrow Right

Grant Accountant

We are looking for a detail-oriented Grant Accountant to join our team in Vernon...
Location
Location
United States , Vernon
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience managing grant accounting activities, including budget tracking, reporting, and compliance oversight
  • Knowledge of government grant requirements and nonprofit accounting practices, including restricted fund management
  • Ability to prepare reconciliations, journal entries, and financial analyses related to grant-funded operations
  • Familiarity with revenue recognition principles and month-end close processes tied to grants
  • Proficiency with grant management and fund administration in an accounting environment
  • Experience working with Abila MIP or similar nonprofit accounting software
  • Strong analytical skills with the ability to interpret budget variances and maintain accurate financial records
Job Responsibility
Job Responsibility
  • Oversee grant budgets, spending activity, and funding balances to help maintain accurate financial control across active awards
  • Review transactions to confirm costs are properly assigned, permitted under grant terms, and aligned with applicable funding requirements
  • Prepare grant-specific financial schedules, account reconciliations, and supporting documentation for internal review and external reporting
  • Develop and submit financial reports for grantors based on required deadlines, formats, and compliance expectations
  • Support audit activity by organizing records, responding to documentation requests, and assisting with grant-related testing and reviews
  • Partner with program leaders to build grant budgets, evaluate spending trends, and explain budget-to-actual differences
  • Record journal entries and maintain general ledger accuracy for grant revenue, expenditures, and fund classifications
  • Distinguish restricted and unrestricted funding appropriately to support proper accounting treatment and financial reporting
  • Collaborate with development and program teams to provide financial guidance on proposals, reporting obligations, and allowable use of funds
What we offer
What we offer
  • Medical insurance
  • Vision insurance
  • Dental insurance
  • Life insurance
  • Disability insurance
  • 401(k) plan
  • Deferred compensation plan
  • Paid time off for vacation, personal needs, and sick time
  • Paid holidays
Read More
Arrow Right

Hgv Class 1 Driver

Location
Location
United Kingdom
Salary
Salary:
17.00 GBP / Hour
jobs.360resourcing.co.uk Logo
360 Resourcing Solutions
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Fully qualified HGV Class 1 (C+E) driver with a CPC, valid Digi card and a good understanding of Tachograph and WTD rules
  • Reliable and punctual with a flexible approach
  • Good verbal communication with excellent customer service skills and a professional approach
  • Previous Class 1 experience is preferred but not essential
Job Responsibility
Job Responsibility
  • General Haulage
  • Maintain excellent levels customer service
  • Ensure accurate and timely communication with the Transport team
  • Deliver goods in a timely and professional manner
What we offer
What we offer
  • Training opportunities to develop existing skills (ADR, driver assessor, FLT licences)
  • Very well presented modern fleet (MAN, Scania, DAF, Iveco)
  • Permanent contract with minimum agreed hours paid
  • Paid holiday entitlement (28 days per annum inc bank holidays)
  • Workplace pension
  • Overtime availability
  • Full PPE & uniform provided
  • Modern vehicle fleet
  • Funded CPC courses
  • Refer a Friend Incentive (£250 for you + £250 for new starter after 3 months)
  • Fulltime
Read More
Arrow Right