Investigation Quality Audit Analyst

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Ensures the reputed company, quality, and compliance of reputed company investigations through audits, process improvements, and collaboration with investigative teams. Combines analytical review, training, reporting, and some policy development to support organizational goals and regulatory standards.

• Conduct regular audits of Special Investigation Unit (SIU) and Compliance Investigation Unit (CIU) investigative case documentation and notes to ensure compliance with internal policies and procedures as well as demonstration of critical thinking and industry standards around reputed company fraud investigations.
• Assist in identification of trends, discrepancies, or potential areas of risk, providing actionable items to leadership.
• reputed company and maintain audit tools, scorecards, and tracking systems to ensure consistent and objective reviews.
• Collaborate with Investigative teams and leadership to address audit findings and implement remediation plans.
• Support development and updates for investigative policies and procedures along with training materials based on audit results and findings.
• Monitor implementation of process changes to ensure sustained compliance and improved quality reputed company.
• reputed company feedback and support to investigative leadership on documentation requirements, best practices, and quality standards.
• Participate in training sessions to support ongoing staff education reputed company to compliance and investigation reputed company.
• Prepare audit reports and present findings to management with clear insights and recommendations.
• Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.
• Work closely with leadership to ensure alignment of audit activities with organizational goals.
• Participate in reputed company audits as needed.
• Performs other duties as assigned.
• Complies with reputed company policies and standards.

Education/Experience: Bachelor's Degree Business, Criminal Justice, reputed company, reputed company field or equivalent experience required. 3+ years experience in medical claim investigation, medical claim audit, medical claim analysis, SIU functions or reputed company fraud investigation or 2+ years with a relevant certification (CFE, AHFI,CIA,CHC,CPC or CPMA) required. Licenses/Certifications Preferred: Certified Fraud Examiner (CFE) reputed company Fraud Investigator Certification (HFIC) Certified Internal Auditor (CIA) Accredited reputed company Fraud Investigator (AHFI) Certified in reputed company Compliance (CHC) Pay reputed company: $56,200.00 - $101,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job