Attorney in West Des Moines, IA

In-House

West Des Moines, IA

Attorney in West Des Moines, IA

Non-practicing Attorney

Min 5 yrs required

No

Job Title: Investigator Senior

Job Responsibilities:

- The Investigator Senior is primarily tasked with the independent identification, investigation, and development of complex cases aimed at combating healthcare fraud. This involves recovering corporate and client funds that were paid out on fraudulent claims.
- Conducts claim reviews to ensure appropriate coding and utilizes data mining and proprietary data systems for investigating facility, professional, and pharmacy claims.
- Responsible for independently identifying and developing investigations and initiatives that may impact multiple health plans, lines of business, or states within the enterprise.
- Engages with Senior level management and the legal department throughout the investigative process.
- Assists in training both internal and external entities to enhance understanding and efficiency in handling healthcare fraud investigations.
- Plays a role in developing policies and procedures designed to prevent loss of company assets.
- May represent the company in court proceedings relating to research findings.
- Establishes and maintains a high degree of rapport and cooperation with federal, state, and local law enforcement and regulatory agencies to facilitate investigative efforts.

Education and Experience Information:

- The position requires a BA/BS degree and a minimum of five years of related experience in healthcare insurance, healthcare insurance investigation, or law enforcement. Alternatively, a combination of education and experience that provides an equivalent background is acceptable.
- Preferred qualifications include professional certification such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), Paralegal, Registered Nurse (RN), Juris Doctor (JD), or other job-related designations.
- Knowledge of plan policies and procedures in all facets of benefit programs management, with a strong emphasis on negotiation, is preferred.

Salary Information:

- For candidates working virtually or in-person in the specified locations (California, Colorado, District of Columbia, Maryland, Minnesota, New York, Washington State), the salary range for this position is between $78,400 and $141,120.
- In addition to the salary, the company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions, subject to eligibility requirements.
- The salary offered is based on various legitimate, non-discriminatory factors set by the company, committed to ensuring equal pay opportunities regardless of gender, race, or any other protected category under pay equity laws.
- The salary range is a good faith estimate of possible compensation and may vary based on geographic location, work experience, education, skill level, and market considerations. Bonuses, commissions, and other forms of compensation and benefits are at the company's discretion unless and until paid.

Company Overview:

**Members Only** is a health company committed to improving lives and communities by simplifying healthcare. As a Fortune 25 company with a longstanding history in the healthcare industry, **Members Only** seeks leaders passionate about making an impact on members and communities. The company offers a culture designed to encourage personal and professional growth, with values and behaviors that drive strategy, business outcomes, and shared success.

Work Environment:

**Members Only** operates a Hybrid Workforce Strategy, requiring associates to work onsite at least once per week unless specified as primarily virtual by the hiring manager. Specific onsite requirements are discussed during the hiring process. The health of associates and communities is a top priority, with vaccination against COVID-19 and Influenza required for certain roles.

Equal Employment Opportunity:

**Members Only** is an Equal Employment Opportunity employer, providing equal consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected status. Applicants requiring accommodations during the job application process are encouraged to contact the company for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Jun 26, 2025
Apply for this Attorney in West Des Moines, IA job

Upload Resume:

Apply Later
Email   |   Print

The #1 legal job board in the United States year after year!

Tell us where to send your access instructions:

paywall sign up popp