Attorney in Woodland Hills, CA

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In-House

Woodland Hills, CA

Attorney in Woodland Hills, CA

Non-practicing Attorney

Min 5 yrs required

No

Job Title: Investigator Senior

Job Responsibilities:
The Investigator Senior supports the Payment Integrity line of business and is integral in the independent identification, investigation, and development of complex cases against healthcare fraud perpetrators. This role is crucial for recovering corporate and client funds paid on fraudulent claims. Key responsibilities include:
- Conducting claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and utilizing proprietary data and claim systems to review facility, professional, and pharmacy claims.
- Independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact multiple company health plans, lines of business, and/or states.
- Interfacing internally with senior management and the legal department throughout the investigative process.
- Assisting in the training of internal and external entities.
- Contributing to the development of policies and procedures to prevent the loss of company assets.
- Representing the Company in court proceedings regarding research findings.
- Establishing and maintaining a high degree of rapport and cooperation with federal, state, and local law enforcement and regulatory agencies to aid in investigative efforts.

Education and Experience Information:
The position requires a Bachelor's degree (BA/BS) and a minimum of 5 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 certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designations. Additionally, knowledge of plan policies and procedures in all facets of benefit program management with an emphasis on negotiation is preferred.

Salary Information:
The salary range for the Investigator Senior position varies based on location and is specified for candidates working in person or virtually in certain locations such as California, Colorado, District of Columbia, Maryland, Minnesota, New York, and Washington State. The range is $78,400 to $141,120. Alongside the salary, **Members Only** offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, all subject to eligibility requirements. The salary offered is based on various legitimate, non-discriminatory factors set by the Company, which is committed to ensuring equal pay opportunities regardless of gender, race, or any other protected category.

**Members Only** offers 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. The health of associates and communities is a priority, with vaccination against COVID-19 and Influenza required for certain roles. **Members Only** is an Equal Employment Opportunity employer, ensuring all qualified applicants receive consideration without regard to protected statuses.

Jun 26, 2025
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