Senior Investigator - Fraud, Waste, and Abuse Job at Robert Half (Los Angeles)

New

Special Investigations Unit Senior Investigator

We’re building a world of health around every individual — shaping a more connec...

Location

United States

Salary:

46988.00 - 102000.00 USD / Year

CVS Health

Expiration Date

March 24, 2026

Requirements

3-5 years investigative experience in the area of healthcare fraud and abuse matters
Working knowledge of medical coding
CPT, HCPCS, ICD10
Proficiency in Microsoft Office with advanced skills in Excel (must know how to do pivot tables)
Strong analytical and research skills
Proficient in researching information and identifying information resources
Strong verbal and written communication skills
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)
Bachelor's degree or equivalent experience (3-5 years of working health care fraud, waste and abuse investigations)

Job Responsibility

Conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse
Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of company and customer money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators
Assists Investigators in identifying resources and best course of action on investigations

What we offer

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance

Fulltime

Special Investigations Unit Senior Investigator

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

46988.00 - 91800.00 USD / Year

CVS Health

Expiration Date

March 04, 2026

Requirements

LOUISIANA RESIDENCY REQUIRED
3+ years investigative experience in the area of healthcare fraud and abuse matters
Working knowledge of medical coding
CPT, HCPCS, ICD10
Proficiency in Microsoft Office with advanced skills in Excel (must know how to do pivot tables)
Strong analytical and research skills
Proficient in researching information and identifying information resources
Strong verbal and written communication skills
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)
Bachelor's degree or equivalent experience (3-5 years of working health care fraud, waste and abuse investigations)

Job Responsibility

Conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse
Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of company and customer money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators
Assists Investigators in identifying resources and best course of action on investigations

What we offer

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance

Fulltime

!

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

The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (F...

Location

United States , Los Angeles

Salary:

135136.00 - 216218.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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

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

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Director, Deputy Corporate Compliance & Operations

Aledade's Compliance & Ethics organization is seeking a tenured and strategic he...

Location

United States , Arlington; Austin; Durham; Novi; Bethesda

Salary:

Not provided

Aledade, Inc.

Expiration Date

Until further notice

Requirements

Bachelor's degree or equivalent combination of education and experience
+12 years of experience, with a minimum of 8 years of progressive experience in healthcare compliance, with a strong focus on corporate compliance operations
Experience leading compliance operations teams
Experience presenting and reporting to the Board of Directors
Strong knowledge of HIPAA, fraud, waste, and abuse laws (Stark Law, Anti-Kickback Statute, False Claims Act)
Excellent analytical, problem-solving, and critical thinking skills
Exceptional written and verbal communication skills, with the ability to translate complex data findings into clear and actionable guidance
Strong interpersonal skills and the ability to collaborate effectively with diverse teams

Job Responsibility

Deputize for the VP, Head of Compliance in providing leadership, oversight and representation for the Compliance Department
Prepare and present compliance reports to senior leadership, Compliance Committee, and the Board of Directors
Oversee and continually enhance Aledade’s Corporate Compliance Program, ensuring alignment with OIG compliance program guidance, industry best practices, and Aledade’s strategic objectives
Establish and maintain a strong compliance governance framework, including policy standards, committee structures, and reporting mechanisms
Develop and manage compliance training and education programs to ensure business relevant and effective programs
Lead and manage compliance the day-to-day operations, including policy governance, reporting & investigations, conflict of interest, exclusion screening, training & education, and compliance communications
Oversee the intake, internal investigations, and resolution of compliance concerns and reports to ensure consistent application of policies, procedures, and corrective actions
Partner with Legal, Privacy, Security, and People teams to ensure coordinated approaches to compliance risks
Lead special projects on behalf of the VP, Head of Compliance, including compliance program optimization, technology enablement, and corporate transaction readiness
Supervise and mentor compliance team members, fostering professional growth and operational excellence

What we offer

Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options

Fulltime

New

Inventory Manager

The Inventory Manager is accountable for the Market Center’s product inventory, ...

Location

United States , Indianapolis

Salary:

Not provided

Aramark

Expiration Date

Until further notice

Requirements

Requires a minimum of 3-5 years of relevant experience in warehouse or related operations
Requires a bachelor's degree or equivalent experience
Strong verbal and written communication skills
Requires tact and courtesy dealing with internal and external contacts
Excellent teamwork, problem solving, organizational, and interpersonal skills
Strong attention to detail
Ability to learn recent technologies
Basic Microsoft Excel knowledge
Communication skills including verbal, written, and the ability to connect with a wide range of people and behavior styles
Must be physically able to lift, lower, push and pull objects up to 50 lb. unassisted

Job Responsibility

Achieves financial objectives by participating in budget process, managing key metrics, identifying opportunities, and developing action plans for improvement
Procures products by setting a purchasing schedule, coordinating with vendors, and using the warehouse ordering tool to create purchase orders
Maintains the warehouse system to reflect accurate par levels of product, inventory level and accurate product master set-up
Implements food safety requirements through First-in, First-out (FIFO) product rotation, managing date codes, and ensuring temperature requirements are met
Controls inventory levels and product costs by coordinating/conducting weekly physical counts and working closely with the Finance Manager to resolve inventory overages and shortages
Optimizes inventory by analyzing trends, and improving product days-on-hand, client fill rate metrics, and other key product metrics
Communicates with affected managers and front-line personnel regarding any voids, delays or other product changes that may affect client delivery as well as discussing alternative product needs where required to meet client demand
Communicates with vendors as needed to ensure timely delivery of ordered products and equipment
Leads warehouse workforce that receives, stocks, rotates, and pulls product and ensures that work is completed using safe practices
Participates in the hiring process for the warehouse team

Fulltime

New

Level 2/3 Nursery Practitioner

Join our team as a Level 3 Qualified Nursery Practitioner. We are looking for so...

Location

United Kingdom , Wombourne

Salary:

25896.00 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Level 3 Early Years qualification or Qualified Teacher Status (QTS)
Right to work in the UK (no sponsorship offered)

Job Responsibility

Create a warm, fun, and nurturing environment where children feel safe and thrive
Plan and deliver engaging, play-based activities aligned with the EYFS framework
Build meaningful relationships with children, families, and colleagues
Monitor and celebrate children’s development milestones, keeping records to share with parents
Support the day-to-day running of the nursery, maintaining high standards of hygiene, safety, and care
Be a team player, offering guidance to apprentices and volunteers while learning from others

What we offer

Free childcare for the first month and 52% discount (based on working hours)
31 days of holiday (inclusive of national bank holidays and the Christmas closure week)
Birthday off
Access to The National College full of training and courses
Perkbox discounts, wellbeing tools, and online medical services
Refer a friend or family for exciting bonuses
Long-service awards
1 paid day off per year to volunteer

Fulltime

New

Managers Control Self-Assessment (MCA) Lead Analyst

Individuals in MCA are responsible for designing and implementing a comprehensiv...

Location

Costa Rica , Heredia

Salary:

Not provided

Citi

Expiration Date

Until further notice

Requirements

Minimum of 6-10 years of experience in operational risk management, compliance, audit, or other control-related functions in the financial services industry
Ability to identify, measure, and manage key risks and controls
Strong knowledge in the development and execution for controls
Proven experience in control related functions in the financial industry
Proven experience in implementing sustainable solutions and improving processes
Understanding of compliance laws, rules, regulations, and best practices
Understanding of Citi’s Policies, Standards, and Procedures
Strong analytical skills to evaluate complex risk and control activities and processes
Strong verbal and written communication skills, with a demonstrated ability to engage at the senior management level
Strong problem-solving and decision-making skills

Job Responsibility

Support control activities of the Managers Control Self-Assessment (MCA) program, also known as Risk & Control Self-Assessment (RCSA)
Assist & oversee the MCA program, including the annual/semi-annual/quarterly/monthly attestation, quality oversight, and related reporting
Identify, analyze, and assess potential risks, ensuring timely identification and remediation of significant control issues and operational events
Support the execution of the MCA in accordance with the ORM Policy & Framework, as well as applicable Policies, Standards, and Procedures
Develop and maintain ORM tools and methodologies to support accurate and consistent assessments of the risk and control environment
Regularly monitor key performance indicators (KPIs) and evaluate the effectiveness of risk and controls • Recommend enhancements or improvements as necessary to the MCA
Maintain a robust tracking and reporting MCA inventory including key metrics to provide visibility on the status of control gaps and MCA quality control processes
Drive MCA best practices, transformation, and execution consistency across business/functions
Appropriately assess risk when business decisions are made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency, as well as effectively supervise the activity of teams and create accountability with those who fail to maintain these standards

Fulltime

New

Quality Specialist

DCS is seeking a highly motivated, mid-career professional with experience in Qu...

Location

United States , Fort Belvoir

Salary:

Not provided

DCS Corporation

Expiration Date

Until further notice

Requirements

U.S. Citizenship is required
Must have a DOD Secret clearance
Bachelor's and 15 years of experience
Subject matter expert for Quality and the ability to lead Quality efforts on assigned programs with minimal oversight from the Government lead
ISO 9001:2015 Quality System Requirements and Auditing
Equivalent or experience commensurate with DAWIA PQM certification
Ability to travel up to 25%

Job Responsibility

Serves as a Quality Assurance Specialist for Army acquisition programs
Develops quality assurance related input for acquisition management documents to include acquisition plans and strategies, source selection evaluation plans, supportability strategies, system engineering plans, statements of work, test plans and specifications, and ensures appropriate contract clauses are included in contracts
Coordinates with product managers, users, test and evaluation command, and other Government agencies as needed to translate operational and mission needs into practical system concepts and specifications
Plans, develops, implements, and manages the quality management program on assigned programs over their acquisition life cycle
Ensures that design/manufacturing vendors meet their responsibilities for product quality in accordance with the contract requirements, and that systems fielded to Soldiers are of high quality and meet user requirements
Reviews and evaluates system performance, assesses risk, and makes recommendations with respect to product acceptability
Assures compliance with contract scope, schedules, specifications, and other requirements, and when appropriate, recommend program and contract changes
Possesses a working knowledge and practice of MIL-STD-1916, ANSI Z1.4, and other industry standards for quality
Conducts audits of contractor quality management systems, system assembly, and test procedures
Evaluates contractor quality data, metrics, and process controls

Fulltime

Senior Investigator - Fraud, Waste, and Abuse

Robert Half

Location:
United States , Los Angeles

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 01, 2026

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