Legal Staff Paralegal in Woodland Hills, CA

In-House

Woodland Hills, CA

Legal Staff Paralegal in Woodland Hills, CA

Legal Staff

Min 5 yrs required

No

Job Title: Investigator Senior

Job Responsibilities:
The Investigator Senior role supports the Payment Integrity line of business and is primarily focused on identifying, investigating, and developing complex cases against healthcare fraud perpetrators to recover funds for the company and its clients. Responsibilities include:
- Conducting claim reviews for appropriate coding and data mining.
- Engaging in entity reviews, law enforcement referrals, and using proprietary data and claim systems to review facility, professional, and pharmacy claims.
- Identifying and developing enterprise-wide healthcare investigations that may impact multiple health plans, lines of business, or states.
- Interfacing internally with senior management and the legal department throughout the investigative process.
- Assisting in training internal and external entities.
- Developing policies or procedures to prevent the loss of company assets.
- Representing the company in court proceedings regarding research findings.
- Maintaining rapport and cooperation with federal, state, and local law enforcement and regulatory agencies to assist in investigative efforts.

Education and Experience Information:
- A Bachelor’s degree (BA/BS) is required.
- A minimum of 5 years of related experience in healthcare insurance, healthcare insurance investigation, or law enforcement is necessary.
- A combination of education and experience that provides an equivalent background may be considered.

Preferred Qualifications, Skills & Capabilities:
- Professional certifications such as CFE (Certified Fraud Examiner), AHFI (Accredited Healthcare Fraud Investigator), CPC (Certified Professional Coder), Paralegal, RN (Registered Nurse), JD (Juris Doctor), or other job-related designations are preferred.
- Knowledge of plan policies and procedures, especially in benefit programs management and negotiation, is preferred.

Salary Information:
For candidates working in California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, New York, and Washington State, the salary range for this position is $78,400 to $141,120. In addition to the salary, the company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, subject to eligibility requirements. The salary offered is based on several legitimate, non-discriminatory factors set by the company, and it is committed to ensuring equal pay opportunities for equal work regardless of gender, race, or other protected categories.

Company Overview:
**Members Only** is a health company focused on improving lives and communities by making healthcare simpler. As a Fortune 25 company with a longstanding history in the healthcare industry, **Members Only** seeks leaders at all levels who are passionate about impacting members and the communities served.

Work Environment:
**Members Only** operates under a Hybrid Workforce Strategy, requiring associates to work at a company location at least once per week unless specified as primarily virtual by the hiring manager. Specific onsite requirements will be discussed during the hiring process. The company prioritizes the health of its associates and communities, requiring vaccination against COVID-19 and Influenza for new candidates in certain roles, unless an acceptable explanation is provided.

Equal Employment Opportunity:
**Members Only** is an Equal Employment Opportunity employer, providing equal consideration for employment without regard to various protected categories. Applicants requiring accommodation in the job application process can contact the company for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Jun 26, 2025
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