CrawlJobs Logo

Senior Investigator - Fraud, Waste, and Abuse

United States, Los Angeles · Job Posted March 01, 2026
Apply Position
Job Link Share

Job Description

We are looking for a dedicated Senior Investigator specializing in Fraud, Waste, and Abuse to join our team on a long-term contract basis. This position offers the opportunity to contribute to meaningful work in the non-profit sector, ensuring compliance and safeguarding organizational integrity. Based in Los Angeles, California, this role requires an experienced and detail-oriented individual capable of conducting thorough investigations and implementing effective strategies to address complex compliance matters.

Job Responsibility

  • Collaborate with the risk management department to address open and pending investigations, ensuring timely resolution
  • Develop and execute plans to review and prioritize pending claims based on urgency and deadlines
  • Conduct impartial, detailed investigations into allegations of fraud, waste, and abuse
  • Analyze and review contracts between the organization and various parties for potential compliance issues
  • Interview relevant individuals and gather necessary documentation to support investigative findings
  • Prepare comprehensive reports summarizing investigation outcomes and recommendations
  • Maintain accurate and updated logs of ongoing investigations to ensure transparency and accountability
  • Assess risks and implement measures to mitigate potential compliance challenges
  • Support auditing processes to strengthen anti-money laundering (AML) and compliance efforts

Requirements

  • Minimum of 7 years of experience in fraud investigation, compliance, or a related field
  • Certified in Risk and Information Systems Control (CRISC) or an equivalent certification
  • Strong expertise in anti-money laundering (AML) procedures and compliance regulations
  • Proven ability to conduct interviews and gather evidence in sensitive investigations
  • Extensive knowledge of risk assessment and mitigation strategies
  • Proficient in preparing detailed investigative reports and documentation
  • Excellent analytical and problem-solving skills with attention to detail
  • Familiarity with audit compliance processes and fraud detection techniques

What we offer

  • medical
  • vision
  • dental
  • life and disability insurance
  • company 401(k) plan

Looking for more opportunities?

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

Similar Jobs for

Senior Investigator - Fraud, Waste, and Abuse

8 matching positions

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...
Location
Location
United States , Deerfield
Salary
Salary:
224000.00 - 280000.00 USD / Year
https://www.baxter.com/ Logo
Baxter
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Juris Doctor (JD) from an accredited law school
  • admission to practice in relevant jurisdiction, active member in good standing
  • Strong academic record
  • Significant experience advising commercial teams in the healthcare/life sciences space on fraud and abuse laws
  • In-house experience supporting a pharmaceutical and/or medical device company will be highly desireable
  • Familiarity with regulatory frameworks governing medical devices and pharmaceuticals
  • Strong understanding of pharmaceutical and/or medical device commercialization
  • Exceptional oral written communication skills, including drafting skills and presentation capabilities
  • Excellent interpersonal and conflict resolution skills and ability to work in a highly collaborative, team-oriented environment
  • Ability to maintain an independent and objective perspective while developing and maintaining a strong partnership with the business and other functions
Job Responsibility
Job Responsibility
  • Provide legal guidance on arrangements that implicate referral, purchasing, influence, or reimbursement risk
  • Counsel the business on fraud and abuse laws, discount safe harbors, value-based arrangements and other commercial and regulatory areas
  • Develop internal expertise, programs and policies to ensure compliance with fraud and abuse laws
  • Serve as a legal representative on enterprise and cross-functional teams and projects
  • Support internal investigations and responses to government inquiries related to fraud and abuse topics
  • Assist in the auditing of the business and development and execution of remediation strategies
  • Monitor enforcement trends and other legal, regulatory, and governmental developments on fraud and abuse issues impacting the business
  • Advise leadership of emerging risks related to innovative contracting and market access models
  • Direct and manage outside counsel efficiently when needed
What we offer
What we offer
  • Medical and dental coverage that start on day one
  • Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
  • 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
  • Flexible Spending Accounts
  • Educational assistance programs
  • Paid holidays
  • Paid time off ranging from 20 to 35 days based on length of service
  • Family and medical leaves of absence
  • Paid parental leave
  • Fulltime
Read More
Arrow Right

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...
Location
Location
United States , Deerfield
Salary
Salary:
224000.00 - 280000.00 USD / Year
https://www.baxter.com/ Logo
Baxter
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Juris Doctor (JD) from an accredited law school
  • admission to practice in relevant jurisdiction, active member in good standing
  • strong academic record
  • significant experience advising commercial teams in healthcare/life sciences on fraud and abuse laws
  • familiarity with regulatory frameworks governing medical devices and pharmaceuticals
  • strong understanding of pharmaceutical and/or medical device commercialization
  • exceptional oral and written communication skills
  • excellent interpersonal and conflict resolution skills
  • ability to work in a collaborative, team-oriented environment
  • ability to maintain an independent and objective perspective
Job Responsibility
Job Responsibility
  • Provide strategic legal counsel for Baxter International
  • primary focus on compliance with US Fraud, Waste & Abuse laws (False Claims Act, federal Anti-Kickback Statute, Stark Law, related reimbursement and coverage issues, applicable state analogues)
  • provide practical, business-enabling advice to help reduce risk and help the business understand fraud and abuse laws and develop compliance strategies
  • FCA/AKS Counseling & Risk Management: provide legal guidance on arrangements that implicate referral, purchasing, influence, or reimbursement risk (GPO, IDN, regional and local agreements with customers
  • non-commercial arrangements with customers involving an exchange of value
  • distributor and sales-agent agreements
  • consulting, speaker, advisory board, and clinical education programs
  • grants, donations, sponsorships, and charitable contributions
  • data purchase, market research, and service agreements with HCPs and compliance with Sunshine Act
  • arrangements with customers when there are complaints about product performance
What we offer
What we offer
  • Medical and dental coverage that start on day one
  • insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan (ESPP) with ability to purchase company stock at a discount
  • 401(k) Retirement Savings Plan (RSP) with employee contributions and company matching
  • Flexible Spending Accounts
  • educational assistance programs
  • time-off benefits: paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, paid parental leave
  • commuting benefits
  • Employee Discount Program
  • Employee Assistance Program (EAP)
  • Fulltime
Read More
Arrow Right

Senior Investigator, Special Investigations Unit (Aetna SIU)

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States
Salary
Salary:
46988.00 - 112200.00 USD / Year
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3-5 years investigative experience in the area of healthcare fraud, waste and abuse
  • Experience in in Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research
  • Ability to travel approximately 10% of time for business purposes
Job Responsibility
Job Responsibility
  • Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse
  • Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers
  • Research and prepare cases for clinical and legal review
  • Document all appropriate case activity in case tracking system
  • Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law
  • Facilitate the recovery of company and customer money lost as a result of fraud, waste and abuse
  • Cooperate with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud
  • Demonstrate high level of knowledge and expertise during interactions with internal and external partners
  • Provide trial testimony in support of criminal or civil proceedings
  • Give frequent presentations to internal and external customers regarding ongoing case investigations
What we offer
What we offer
  • Medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • bonus, commission or short-term incentive program
  • Fulltime
Read More
Arrow Right

Special Investigations Unit Senior Investigator

Conduct high level, complex investigations of known or suspected acts of healthc...
Location
Location
United States
Salary
Salary:
46988.00 - 112200.00 USD / Year
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 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+ years of working health care fraud, waste and abuse investigations)
Job Responsibility
Job Responsibility
  • 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
  • Serves as back up to the Team Leader as necessary
What we offer
What we offer
  • Medical, dental, and vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • and other resources based on eligibility
  • Fulltime
Read More
Arrow Right

Science Teacher

Justteachers are working closely with a well‑run and forward‑thinking Secondary ...
Location
Location
United Kingdom , King's Lynn
Salary
Salary:
Not provided
justteachers.co.uk Logo
justteachers
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Qualified Teacher Status (QTS) or an equivalent qualification
  • Two recent references
  • Recent experience teaching Science in a UK Secondary school
  • Confidence managing practical work within a laboratory setting
  • Clear classroom presence and effective organisational skills
Job Responsibility
Job Responsibility
  • Teach Science across KS3 and KS4, following clearly sequenced schemes of work
  • Deliver practical investigations safely, ensuring adherence to health and safety expectations
  • Monitor attainment and progress, using assessment to shape future lessons
  • Support pupils in preparing for assessments and examinations
  • Maintain a focused and respectful learning environment
  • Fulltime
Read More
Arrow Right

Assistant Sous Chef

Management position that focuses on successfully accomplishing the daily objecti...
Location
Location
United States , Dearborn
Salary
Salary:
26.54 - 28.85 USD / Hour
https://www.marriott.com Logo
Marriott Bonvoy
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High school diploma or GED
  • 5 years experience in the culinary, food and beverage, or related professional area
  • 2-year degree from an accredited university in Culinary Arts, Hotel and Restaurant Management, or related major
  • 3 years experience in the culinary, food and beverage, or related professional area
Job Responsibility
Job Responsibility
  • Develops, designs, or creates new applications, ideas, relationships, systems, or products, including artistic contributions
  • Maintains food handling and sanitation standards
  • Ensures all employees have proper supplies, equipment and uniforms
  • Performs all duties of Culinary and related kitchen area employees in high demand times
  • Oversees production and preparation of culinary items
  • Ensures employees keep their work areas clean and sanitary
  • Works with Restaurant and Banquet departments to coordinate service and timing of events and meals
  • Communicates areas in need of attention to staff and follows up to ensure follow through
  • Supports and assists with new menus, concepts and promotions for the Restaurant outlets and Banquets
  • Assists in determining how food should be presented and creates decorative food displays
  • Fulltime
Read More
Arrow Right

Fire Door Specialist

Are you passionate about ensuring quality and compliance in manufacturing? Do yo...
Location
Location
United Kingdom , Ashford
Salary
Salary:
45000.00 - 50000.00 GBP / Year
https://www.office-angels.com Logo
Office Angels
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Expert knowledge of Fire Doors
  • Knowledge of manufacturing processes is essential
  • AutoCAD experience is essential
  • Solidworks knowledge would be an advantage
  • An understanding of 3rd party accreditation and auditing processes will be highly beneficial
  • The ability to lead the design process and ensure products comply with current test evidence
  • A solid grasp of modern manufacturing processes to drive efficiency and effectiveness
  • methodical, process driven, with compliance experience
Job Responsibility
Job Responsibility
  • Managing the entire lifecycle of manufacturing projects, collaborating with clients and the design team to secure approvals on drawings and specifications
  • Following projects through to manufacturing and despatch, maintaining adherence to technical specifications and quality standards
  • Specifying the correct materials and products for manufacturing
  • Conducting training and toolbox talks for staff on proper manufacturing processes
  • Keeping meticulous manufacturing records to support compliance and quality assurance
  • Utilising CAD, Microsoft Excel, and Word to assist in project design and management
  • Managing the scheduling, cutting, and requisitioning of door sets, as well as ordering necessary materials
  • Communicating effectively with customers and design managers to ensure all requirements are met
What we offer
What we offer
  • Free parking
  • 22 days of annual leave
  • Company t-shirt, gilet, and coat
  • Opportunities for professional development and career advancement
  • Be part of a team that values creativity and innovation in manufacturing
  • Work alongside a passionate team committed to excellence and teamwork
  • Fulltime
Read More
Arrow Right

Art Teacher

Join a welcoming secondary school in Rugby as a full-time Art Teacher through Ju...
Location
Location
United Kingdom , Rugby
Salary
Salary:
Not provided
justteachers.co.uk Logo
justteachers
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Qualified Teaching Status or equivalent
  • A minimum of two references from educational background or school setting
  • Excellent communication and teamwork skills
  • Proven experience teaching Art to a GCSE level
Job Responsibility
Job Responsibility
  • Collaborate closely with the Creative Arts department to support teaching and learning
  • Adapt teaching to suit different student learning styles
  • Managing classroom behaviour
  • To teach across KS3 and KS4, including full classroom responsibilities
  • Fulltime
Read More
Arrow Right