Special Investigation Unit Investigator III (PHX AND DALLAS)
Role: Special Investigation Unit Investigator III Duration: Contract Hours: Mon - Fri 8a - 5p West-Coast hours Location: 100% remote Pay: $40 - $50/hour
About the Role
Join the nation’s largest publicly operated health plan to lead complex healthcare fraud, waste, and abuse investigations across Medi?Cal and Medicare. This senior SIU role handles high?impact cases and serves as a subject matter expert, mentor, and audit lead. What You’ll Do
- Lead end?to?end investigations of suspected provider, member, and pharmacy fraud
- Analyze claims data, billing patterns, and fraud leads to identify irregularities
- Develop investigative strategies and produce clear, defensible reports
- Partner with agencies (DHCS, CMS, DOJ, law enforcement) and support referrals
- Lead onsite audits, testify when needed, and support recovery efforts
- Mentor junior investigators and provide training on investigative best practices
Key Details
- Caseload: ~75–85 active cases (transportation, pharmacy; no dental/hospital)
- Focus: Primarily Los Angeles County/California
- Training: Structured 2?week onboarding + ongoing development
- Goal: ~100?day case resolution depending on complexity
- Fast start: onboarding within ~3–5 days of offer
What You Bring
- 5+ years in healthcare fraud investigation or related specialty
- Strong clinical/claims review and data analysis skills (Excel required)
- Experience with interviews, evidence development, and case reporting
- Knowledge of CMS/Medicare/Medi?Cal guidelines preferred
Preferred
- Certifications: CFE, AHFI, CPC
- Experience across multiple specialties (Pharmacy, DME, Behavioral Health, etc.)
Remote Skills: Analysis Skills, Behavioral Health, Best Practices, Billing, Centers for Medicare and Medicaid Services (CMS), Certified Financial Examiner (CFE), Content Management Systems (CMS), Data Analysis, Durable Medical Equipment, Fraud Investigation, Health Plan, Healthcare, Hospital, Law Enforcement, Medicare, Mentoring, Onboarding, Pharmacy, Strategic Planning, Training/Teaching, United States Department of Justice (DOJ) About the Company: The Intersect Group The Intersect Group is a different and better business partner. We create unparalleled value for our clients by combining industry-leading Consulting capabilities with comprehensive Staffing and recruitment services. Clients trust us to deliver results based on our deep expertise and proven resources within finance, accounting, and information technology. Through our flexible delivery approach, you get the right solution, at the right time to accelerate your success and achieve all of your mission-critical objectives. Company Size: 500 to 999 employees Industry: Staffing/Employment Agencies Founded: 2006 Apply tot his job Apply To this Job