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

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...

Location

United States , Deerfield

Salary:

224000.00 - 280000.00 USD / Year

Baxter

Expiration Date

Until further notice

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

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

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

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...

Location

United States , Deerfield

Salary:

224000.00 - 280000.00 USD / Year

Baxter

Expiration Date

Until further notice

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

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

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

Senior Investigator, Special Investigations Unit (Aetna SIU)

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

Location

United States

Salary:

46988.00 - 112200.00 USD / Year

CVS Health

Expiration Date

Until further notice

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

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

Medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program

Fulltime

Special Investigations Unit Senior Investigator

Conduct high level, complex investigations of known or suspected acts of healthc...

Location

United States

Salary:

46988.00 - 112200.00 USD / Year

CVS Health

Expiration Date

Until further notice

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

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

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
and other resources based on eligibility

Fulltime

Associate Director - Spending Account Operations

The Associate Director, Spending Account Operations is responsible for leading a...

Location

United States , Boston

Salary:

105000.00 - 115000.00 USD / Year

Alera Group

Expiration Date

Until further notice

Requirements

WEX experience
5+ years of experience in spending account operations (HSA, FSA, HRA, commuter benefits)
5+ years of experience in client success, account management, claims, or related functions
2+ years of leadership experience leading client-facing or operational teams
Strong knowledge of IRS regulations and compliance related to spending accounts
Experience working with spending account platforms and technology
Proficiency in Excel (pivot tables, VLOOKUP) and CRM/tools (e.g., Zoho or similar)
Proven ability to lead teams, drive process improvements, and optimize service delivery
Strong communication and relationship management skills with the ability to resolve complex issues
Demonstrated strategic thinking, analytical, and problem-solving skills

Job Responsibility

Leads, manages, and develops a high-performing team responsible for claims administration, funding reconciliation, and data analysis
Provides coaching, feedback, and performance evaluations through structured processes such as 15Five check-ins, L10 meetings, and 1:1s
Ensures team alignment with strategic objectives, performance metrics, and compliance standards while fostering a culture of continuous learning and professional growth
Ensures best-in-class client service by coaching and mentoring team members to resolve client issues efficiently and proactively
Serves as the final escalation point for complex claims, funding discrepancies, and reporting concerns
Implements preventative measures to enhance client experience and optimize service delivery
Monitors client retention metrics and identifies areas for service enhancement and process improvements
Establishes and enforces best practices for claims processing, funding reconciliation, and data integrity
Ensures regulatory compliance with IRS guidelines and industry standards related to HSAs, FSAs, HRAs, and Commuter Benefits
Works with internal teams to maintain data accuracy and process efficiency across all systems

What we offer

medical
dental
vision
life and disability coverage
401(k)
generous PTO
Role-specific learning paths
Leadership development programs
Technical and compliance training
Industry certifications and continuing education support

Fulltime

Control Automation Engineer

A minimum of 4-8 years of experience. Successfully completed an engineering degr...

Location

India , Pune

Salary:

Not provided

Randstad

Expiration Date

August 05, 2026

Requirements

A minimum of 4-8 years of experience
Successfully completed an engineering degree
Experience in application development
Implementation and testing of automation software components for production systems and their (industrial communication) interfaces
Responsibility for conducting simulations, tests, and error analyses to validate the solutions you develop in our agile work environment
Migration, maintenance and enhancements of existing automation components
Supporting internal customers
Knowledge in the use of Azure DevOps, Git, Linux, and automation software ( SCADA & HMI )
Experience with JAMA Connect Software for tracking of Requirements and creation of software tests
Experience with scripting languages (e.g., Python) is an advantage

Job Responsibility

Implementation and testing of automation software components for production systems and their (industrial communication) interfaces
Responsibility for conducting simulations, tests, and error analyses to validate the solutions you develop in our agile work environment
Migration, maintenance and enhancements of existing automation components
Supporting internal customers

Fulltime

Administrative Assistant

We are looking for an organized Administrative Assistant to support benefit-rela...

Location

United States , Manorville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in administrative support, office coordination, or a similar clerical role
Ability to manage detailed records, complete forms accurately, and maintain organized documentation
Strong communication skills with the ability to interact professionally with government agencies, staff, and stakeholders
Proficiency in data entry, document tracking, and general office administrative tasks
Comfortable handling inbound calls and providing front-office or receptionist support when needed
Strong attention to detail and the ability to follow through on multiple time-sensitive assignments
Experience working with benefits administration, eligibility documentation, or public assistance programs is preferred
Ability to maintain confidentiality and exercise sound judgment when working with sensitive personal and financial information

Job Responsibility

Coordinate with agencies such as Social Security, Medicaid, and the Veterans Administration to help maintain ongoing benefits eligibility for program participants
Prepare, submit, and track benefit applications, renewals, and recertification paperwork while ensuring required information is complete and accurate
Update agency records when changes occur in housing, income, or other eligibility-related circumstances, and verify related budget adjustments
Partner with accounting personnel and external benefit offices to confirm excess income is reported properly and resolved in a timely manner
Research payment issues, assist with lump-sum Social Security matters, and help address overpayment concerns through appropriate follow-up
Maintain organized files and supporting documentation for pooled trust records, insurance information, and other required administrative materials
Support program staff by answering questions related to eligibility, budgeting, and coverage records, helping protect continued access to benefits
Review benefit budgets and case details regularly, identify discrepancies, and take corrective action when documentation or reporting updates are needed
Monitor disability claim activity and Social Security redeterminations, following up on outstanding updates and completing required administrative steps
Perform general administrative support duties such as data entry, inbound call handling, reception coverage, account follow-up, and other assigned office tasks

What we offer

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

Fulltime

Machine Learning Engineer

We are seeking a talented Machine Learning Engineer to design and build advanced...

Location

United Kingdom , Glasgow

Salary:

Not provided

Barclays

Expiration Date

Until further notice

Requirements

Proven experience in machine learning development, including training and/or deploying models in production environments
Strong programming skills in Python
Experience working with distributed data processing frameworks (e.g., Spark)
Familiarity with deep learning or NLP frameworks (e.g., PyTorch, Hugging Face)
Good understanding of software engineering principles and machine learning lifecycle practices (MLOps/LLMOps)
Experience contributing to ML projects and working with cross-functional stakeholders

Job Responsibility

Design and build advanced machine learning and AI solutions that enhance our ability to detect financial crime, prevent fraud, and safeguard our customers
Developing scalable ML pipelines, building production-ready model code, and supporting robust monitoring systems
Contribute across the full machine learning lifecycle, from initial concept and data exploration through to deployment, while ensuring adherence to governance, documentation, and regulatory standards

What we offer

Fitness Suite
fitness classes
on-site GP
bicycle store
rooftop bar, The Beacon

Fulltime

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Senior Investigator - Fraud, Waste, and Abuse

Job Description

Job Responsibility

Requirements

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