compliance investigator

Otsuka ICU Medical LLC

<div><p><b>Responsibilities
</b></p><p>Conduct investigations into process excursions, procedural exceptions and nonconforming events that contribute to the root cause of customer complaints. Ensure root cause, corrective action preventative action (CAPA), and product impact are thoroughly addressed in investigations. Synthesize recommendations for action based on procedural requirements, decision flowcharts, and critical thinking. Document investigations results. Develop, implement, manage and track effectiveness of corrective action plans for exceptions. Provide training and conduct verification assessments to ensure adequate maintenance of quality systems and processes as required. Manage projects to ensure they are completed within the required time schedule as required per quality systems. Provide support activity during regulatory or 3rd party audits. Prepare departmental metrics. Utilize trend data to develop schedule and incorporate into facility investigations. Ensure accurate project schedules are maintained and communicated to management. Write field alert report and prepare and deliver notifications to management. Participate on committees/teams supporting GMP compliance programs. Adhere to all company guidelines, SOPs and ensure required compliance training is up to date. Monitor GMP and regulatory compliance activities critical in a regulatory inspection. Communicate GMP violations and quality systems deficiencies to management and recommend MQ product release holds until the violation is addressed. Perform other related duties as assigned or required. *Work from home permitted. When not working from home, must report to Austin, TX office. *&lt; 5% domestic travel required per year.
</p><p><b>EDUCATION AND EXPERIENCE REQUIREMENTS:
</b></p><p>Bachelor&rsquo;s degree (or foreign equivalent) in Industrial Engineering, Manufacturing Engineering, or closely related field plus two (2) years of experience in Quality, Manufacturing, Engineering, R&amp;D Functions, job offered, or closely related occupation.
</p><p><b>SPECIAL REQUIREMENTS:
</b></p><p>Must possess expertise/knowledge sufficient to adequately perform the duties of the job being offered. Expertise/knowledge may be gained through employment experience or education. Such expertise/knowledge cannot be &ldquo;quantified&rdquo; by &ldquo;time.&rdquo; Required expertise/knowledge includes: Experience with Manufacturing principles including one or more of the following: Good Manufacturing Practices (GMP), Technical writing, and Quality Management System (QMS) business process experience; Experience with problem solving using Root Cause Analysis tools; Experience with regulatory requirements including 21 CFR part 11, 210 &amp; 211; Experience effectively communicating with all levels of management through writing and/or presentation; Experience recommending continuous improvement plans where necessary using the Six Sigma and/or DMAIC methodologies; Experience fostering a participative approach to problem-solving by conducting cross-functional team meetings and presenting significant events to leadership for input; Experience with corrective action follow up utilizing technical expertise and negotiation skills to bridge the gaps between Quality and Manufacturing requirements.
</p><p>Otsuka ICU Medical, LLC is an equal opportunity employer.
</p><p>To apply for Otsuka ICU Medical, LLC&rsquo;s Compliance Investigator position please send resume to: humanresouces&amp;#64;icumed.com
</p><p>Must reference <b>JOB CODE: </b>TX1224HA</p></div><p></p>
<br><p></p><div><p>Innovation, Impact, and Purpose.
</p><p>Find Your Future Here.
</p><p>We manufacture the critical IV solutions providers count on to deliver consistent, reliable care. Each product we make helps ensure patients receive the therapies they need without disruption.
</p><p>When you work here, you become part of something bigger&mdash;a team dedicated to reliability and innovation. No matter the role, your work directly strengthens the healthcare supply chain and impacts patients nationwide.
</p><p>We offer opportunities for growth, collaboration, and meaningful contributions, all in pursuit of a mission that truly matters.
</p><p>Join us and help shape the future of IV solutions.
</p><p>EEO Statement:
</p><p>Otsuka ICU Medical is committed to being an Equal Opportunity Employer. We ensure that all qualified applicants receive fair consideration for employment regardless of race, color, nationality or national origin, ethnicity, sex, gender, religion or belief, marital or civil partnership status, sexual orientation, pregnancy or maternity, age, disability, or protected veteran status.
</p><p>If you are an individual with a disability and need reasonable accommodation to participate in the employment selection process, please contact us at austinhr@icumed.com. We are committed to providing equal access and opportunities for all candidates.
</p><div><p>Otsuka ICU Medical EEO Policy Statement
</p><p>Know Your Rights: Workplace Discrimination is Illegal Poster
</p><p>Otsuka ICU Medical CCPA Notice to Job Applicants</p></div></div>

Compliance Investigator

Qatar Foundation

<div>
 <p>
  <strong>
   JOB PURPOSE:
  </strong>
 </p>
 <p>
  To support the Head of Compliance Reviews and Investigations in managing and overseeing Compliance Reviews, QF investigations, Whistleblowing hotline cases, Conflicts of Interests, and other Compliance-related breaches. And to manage the intake, assessment, fact-finding, analysis, assisting in preparing Investigation reports and finally to contribute to the continuous improvement of the Compliance Framework.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   KEY RESULT AREAS:
  </strong>
 </p>
 <ul>
  <li>
   Facilitate and supervise Whistleblower submissions, employee concerns and other non-compliances, acting as the first point of contact.
  </li>
  <li>
   Monitor and triage cases received through the QF Whistleblower hotline and other reporting channels.
  </li>
  <li>
   Develop timely logging, categorisation and assignment of cases for review adhering with QF established Policies, Processes and practices.
  </li>
  <li>
   Develop &amp; recommend initial risk assessment on all cases to prioritise cases based on severity, regulatory impact and potential business risk.
  </li>
  <li>
   Conduct detailed compliance reviews and investigations.
  </li>
  <li>
   Evaluate and prepare case files, interview guides and other documentation required for investigations.
  </li>
  <li>
   Implement investigation case management system and ensure proper documentation and evidence handling.
  </li>
  <li>
   Follow up and perform fact-finding, data analysis and background research to support case resolution.
  </li>
  <li>
   Analyze, using analytical tools and identify trends, patterns or control weaknesses based on investigation outcomes.
  </li>
  <li>
   Make recommendations when drafting investigation summaries and when preparing investigation reports for review.
  </li>
  <li>
   Facilitate the Compliance team&rsquo;s efforts to track and follow-up on corrective actions and recommendations arising from investigations, escalating recommendations which require management input.
  </li>
  <li>
   Make recommendations regarding the development and enhancement of wider QF Investigation framework.
  </li>
  <li>
   Make recommendations regarding the development of employee training material relating to Whistleblowing hotline, practices, and systems.
  </li>
  <li>
   Draft periodic reports on Whistleblower cases, key themes and investigation outcomes for management.
  </li>
  <li>
   Generate insights and recommendations to strengthen internal controls and prevent further issues, while continuously seeking opportunities to enhance reporting.
  </li>
  <li>
   Other reasonable tasks as assigned by supervisor.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   MINIMUM KNOWLEDGE, SKILLS &amp; EXPERIENCE:
  </strong>
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree in relevant field (Risk Management, Compliance, Law); or other fields such as Human Resources, Public Administration, Psychology. A Master&rsquo;s degree is a plus.
  </li>
  <li>
   6-8 years of experience in compliance investigations, ethics &amp; Integrity programs, Internal Audit or risk management. Experience working in GCC is preferred.
  </li>
  <li>
   Good experience and knowledge of regulation and legislations in the State of Qatar, including Fraud, Money Laundering, Bribery and Corruption etc.
  </li>
  <li>
   Certification on ACFE; other professional certifications such as CIA, CPA and ACCA are an advantage
  </li>
  <li>
   Sound knowledge of ethics and compliance profession.
  </li>
  <li>
   Analytical and investigative skills - Technically strong and able to draw conclusions based on analysis of data.
  </li>
  <li>
   Excellent teamwork and interpersonal skills and ability to establish and maintain effective working relationships in a diverse multi-cultural environment.
  </li>
  <li>
   Excellent writing skills with the ability to draft and edit a variety of written reports and communications and to articulate ideas clearly and concisely.
  </li>
  <li>
   Proficiency in ERP applications and MS Office applications. And knowledge in CaseWare or other relevant software is an advantage.
  </li>
 </ul>
</div>


Lead Compliance Investigator

Dart Bank & Mortgage

<div><p><b>Job Summary</b></p><p>
</p><p>The Financial Crimes Compliance Fraud Investigator is responsible for conducting comprehensive and in-depth investigations into suspected fraudulent activity across the bank&rsquo;s products and services. This role is focused on the detection, analysis, prevention of fraud and mitigating losses, while ensuring compliance with the Bank Secrecy Act (BSA), USA PATRIOT Act, OFAC requirements, FinCen SAR Reporting requirements, internal fraud prevention policies and procedures and federal, and state laws.
</p><p></p><p><b>Job Duties</b></p><ul><li>
Conduct thorough investigations of escalated alerts and cases involving potentially fraudulent activity, including identity theft, account takeover, wire fraud, check fraud, digital/fintech payment fraud and other financial schemes.</li><li>
Evaluate the quality and completeness of initial reviews performed by analysts and determine whether escalation to case level is appropriate.</li><li>
Review and analyze escalated alerts, internal and external referrals, and third-party data to determine if activity is potentially fraudulent and warrant a case investigation.</li><li>
Ensure investigations are comprehensive, accurate, and conducted in line with internal policies, regulatory expectations, and industry best practices.</li><li>
Evaluate fraud cases to determine SAR filing needs based on regulatory standards and internal thresholds, ensuring timely, accurate, and well-documented justification and reports with comprehensive risk assessments and supporting records.</li><li>
Draft, review, and submit SARs in accordance with FinCEN guidelines and filing timelines, ensuring quality and accuracy in all submissions</li><li>
Utilize investigative tools and customer due diligence materials&mdash;including OSINT, risk scores, KYC profiles, and transaction history&mdash;to develop thorough case assessments and request additional information (RFI) as needed to complete investigation.</li><li>
Collaborate across departments to enhance fraud detection, implement prevention strategies, reduce future risk exposure, and improve fraud detection and investigative procedures.</li><li>
Collaborate cross-functionally with other FCC members and departments to enhance fraud prevention and mitigation initiatives and alert/case-handling efficiency.</li><li>
Stay current on regulatory changes, fraud trends, industry best practices, detection techniques, and emerging threats (e.g., digital fraud, synthetic identity, social engineering).</li><li>
Complete required training and proactively pursue continuing education related to fraud, AML, and financial crime risk management.</li><li>
Assist bank partners with fraud matters and as a resource.
</li><li>Serve as a subject matter expert and escalation point for fraud analysts and specialists.</li><li>
Adheres to all Federal and State laws and regulations, including the Bank Secrecy Act.</li><li>
Other duties as assigned.</li></ul><p>
</p><p><b>Qualifications</b></p><ul><li><b>
Education</b><ul><li>
High School Diploma or equivalent</li></ul></li><li><div><ul><li>
Bachelor&rsquo;s degree in finance, Criminal Justice, Business, or a related field or equivalent experience preferred.</li></ul></div></li><li><b>
Skills</b><ul><li>
Strong analytical and organizational abilities with attention to detail and the capacity to resolve complex case investigations.</li><li>
Exhibits sound and accurate judgment; supports and explains reasoning for decision; makes timely decisions</li><li>
Excellent written and verbal communication skills, with the ability to provide constructive feedback and clear documentation.</li><li>
Strong working knowledge of Fraud, BSA, AML, OFAC, FinCEN guidance, and OCC/FDIC regulatory expectations</li><li>
Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).
</li><li>Highly adaptable, positive, resilient, and open to new ideas. Able to effectively prioritize multiple concurrent projects</li><li>
Analytical and investigation ability to conduct research, brainstorm creative solutions.</li><li>
Ability to communicate effectively, in person and in writing.
</li><li>Possess the ability to work independently, without direct supervision and in a collaborative fast-paced, dynamic environment while maintaining high-quality standards and providing positive support to others</li><li>
Good math aptitude, with mathematical reasoning.</li><li>
Maintains confidentiality, sensitive to confidential materials and matters</li></ul></li><li><b>
Experience</b><ul><li>
Minimum of 3-5 years of experience in Financial Crimes, Fraud and BSA/AML investigations within a banking environment.
</li><li>Involvement in financial crimes professional organization(s), is preferred.</li><li>
Professional Certification (CFE, CFCI, CFCS, CAMS, or other compliance certification), is preferred.</li><li>
Proficiency with Fraud and AML case management and transaction monitoring systems.
</li><li>Experience with novel banking industries such as FinTech, BaaS, and Digital Banking, MRB, is preferred.
</li><li>Excellent analytical, communication, SAR and report-writing skills.</li><li>
Demonstrate strong attention to detail, problem-solving skills, and the ability to prioritize while handling sensitive information with integrity.</li></ul></li></ul><p>
</p><p><b>Essential Functions</b></p><ul><li>
Must be able to perform the essential functions of this position with or without reasonable accommodation.</li></ul><p>
</p><p><b>Supervised By</b></p><ul><li>
Fraud &amp; Identity Theft Program Manager</li></ul><p>
</p><p><b>Supervises</b></p><ul><li>
None</li></ul><p>
Dart Bank is a community bank, serving our community since 1925. We specialize in providing financial services, but we are passionate about serving the community and building real relationships with people. Dart Bank provides innovative financial services for both personal and business banking, consumer and mortgage loans, commercial loans and lines of credit, merchant credit card processing, investment services and more. Our array of products and services and our longstanding history within our communities shows we care about what matters most for our customers and we are there for them for the most important times in their lives. Dart Bank. For What Matters Most.
</p><p>We offer:
</p><ul><li>Medical Benefits
</li><li>Dental
</li><li>Vision
</li><li>401(K) Employee Stock Ownership Plan
</li><li>Paid vacation &amp; sick time
</li><li>Flexible scheduling
</li><li>Employee Assistance Program
</li><li>Dart Bank University
</li></ul><p><i>At Dart Bank you can expect to be surrounded by a team that will support you and invest in your growth in a quick-paced work environment where we deliver exceptional customer service. We are a local business that cares about our employees and our community.
</i></p><p>Dart Bank is committed to providing equal opportunity in employment, maintaining a diverse workforce, and prohibiting all forms of unlawful discrimination and harassment.
</p><p>All employment decisions, policies, and practices, in terms of the recruitment process and other conditions and privileges of employment, will comply with applicable federal, state, and local anti-discrimination laws. The Company seeks, employs, promotes, and compensates qualified individuals based on ability, as demonstrated by performance and other legitimate non-discriminatory factors, without regard to race, color, religion, national origin, citizenship, ancestry, sex (including sexual orientation, gender expression, and gender identity), age, physical or mental disability, pregnancy, genetic information, military status, veteran status, or any other protected status under federal, state (in Michigan: marital status, familial status, height, weight, and misdemeanor arrest record), or local law (individually and collectively, &ldquo;Protected Class&rdquo;). This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the United States. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so that you can begin to resolve the issue before this employer can take any action against you, including terminating your employment. This employer can only use E-Verify once you have accepted a job offer and completed Form I-9.</p></div>

Financial Crimes Compliance Fraud Investigator

State of Missouri

<div>Job Summary - Why you&rsquo;ll love this position
<p><b>Non-Commissioned Investigator or
</b></p><p><b>Senior Non-Commissioned Investigator</b></p>
<p><b>Compliance Tax Investigation Bureau</b></p>
<p><b>Missouri Department of Revenue</b></p>
<p></p><p><b>DOR VISION: To establish an environment that fosters confidence and trust by successfully utilizing technology, employing resources, and meeting customer needs.</b></p>
<p></p><p><b>HOW THIS POSITION SUPPORTS THE DEPARTMENT&rsquo;S VISION:</b></p>
<p>This is a professional public contact work in the Compliance Tax Investigation Bureau of the Missouri Department of Revenue conducting criminal investigations in the areas of sales, withholding, and income taxes for the State of Missouri in reviewing claims to identify fraudulent activity, conducting interviews, preparing detailed reports of investigation findings, and recovering taxes owed to the State of Missouri by initiating collection efforts.</p>
Responsibilities - What you&rsquo;ll do
<p><b>DUTIES PERFORMED TO SUPPORT THE DEPARTMENT&rsquo;S VISION:</b></p>
<ul><li>Issue summons to businesses who are in violation of sales and withholding tax laws.</li>
<li>Conduct assigned investigations of suspected criminal tax violations and incidents by locating and interviewing individuals and representatives of business entities to obtain evidence of suspected violation of tax laws administered by the Department.</li>
<li>Prepare and issue subpoenas to obtain records and information.</li>
<li>Trace funds through banking systems and other institutions and analyze complex financial transactions.</li>
<li>Gather statements from victims, witnesses and suspects, collecting and evaluating pertinent records, obtaining and preparing evidence and preparing detailed reports of completed cases.</li>
<li>Compile, analyze, evaluate statements, prepare affidavits, and other evidence for use in legal proceedings.</li>
<li>Exercise independent judgment and initiative within established laws, policies and procedures.</li>
<li>Work diligently and accurately to complete all assigned work.</li>
<li>Obtain the necessary cooperation and information using considerable tact and diplomacy while representing the Agency in a professional manner.</li>
<li>Provide testimony in criminal, civil, or administrative proceedings.</li>
<li>Ability to travel in the performance of assigned duties.</li>
</ul><p><b>CORE COMPENTENCIES NEEDED:</b></p>
<ul><li>Strategic Thinking</li>
<li>Microsoft Word and Excel</li>
<li>Effective Writing</li>
<li>Self-directed</li>
<li>Attention to Detail</li>
<li>Clear Communication</li><br>
</ul><p></p><br>
Qualifications - All you need for success
<p><b>QUALIFICATIONS:</b></p>
<p>A Bachelor&rsquo;s degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following areas: accounting, finances, tax, banking, marketing, economics, operations management, statistics, criminal justice or a closely related area; or experience as a white collar crime investigator with responsibility for conducting financial or tax investigations. Ability to effectively work and communicate with coworkers and attorneys.</p>
<p><b>SALARY:</b></p>
<p>$48,496 (Non-Commissioned Investigator) or
</p><p>$52,077 (Senior Non-Commissioned Investigator)</p>
Job Details - More reasons to love this position
<p><b>More reasons to love this position:
</b></p><p>The State of Missouri offers an excellent benefits package that includes a defined pension plan, generous amounts of leave and holiday time, and eligibility for health insurance coverage. Your total compensation is more than the dollars you receive in your paycheck. To help demonstrate the value of working for the State of Missouri, we have created an interactive Total Compensation Calculator. This tool provides a comprehensive view of benefits and more that are offered to prospective employees. The Total Compensation Calculator and other applicant resources can be found here.
</p><p><i>Individual(s) selected for this position may receive a higher rate based on a pay differential (e.g., shift or time-of-service pay).</i></p>
Contact Details - If you have questions or require any accommodations to participate in the application or interview process please contact:
<p><b>PLEASE DIRECT ANY QUESTIONS ABOUT THIS POSITION TO:</b></p>
<p>The Missouri Department of Revenue Human Resources office at (573) 751-1291.
</p><p><i>The State of Missouri is an equal opportunity employer.</i></p>
The State of Missouri is an equal opportunity employer and is committed to developing and maintaining a talented workforce.</div>

Non-Commissioned Investigator or Senior Non-Commissioned Investigator - 7022020

State of Ohio

<p></p><div><div><p><b>Lead Customer Service Investigator</b><b> (Investigator)</b></p><p><b>
Service Monitoring &amp; Enforcement Department (SMED)</b></p><p><b>
Consumer Services Division (CSD)</b></p><p><b>
Hourly Rate: $27.92</b></p><p></p><p><b><i><br>
About The Service Monitoring &amp; Enforcement Department:</i></b></p><p>
The Service Monitoring and Enforcement Department&rsquo;s (SMED) mission is to enforce consumer safeguards, to resolve consumer complaints and to ensure Ohio utility consumers receive safe and reliable services. SMED is organized into three divisions.</p><p><b>
Consumer Services Division (CSD)</b></p><p>
CSD includes the PUCO Call Center. Staff in this division educates consumers on their rights and responsibilities for safe and reliable service and mediates simple complaints between consumers and various utility companies. Staff will also mediate more complex disputes by collecting the facts from both parties and applying PUCO policies, rules, and regulations to resolve the dispute, including those received via the chairman, commissioners, and/or legislative liaison. CSD staff audits regulated utility and household goods companies to ensure these companies are following PUCO rules and regulations governing consumer safeguards.</p><p></p><p><b><i><br>
What You Will Do:</i></b></p><p>
In this position as a <b>Lead Customer Service Investigator,</b><b> </b>you will:</p><ul><li>
Serve as the primary point of contact and lead resource for the assigned section of the Customer Service Division (CSD) in the supervisor&rsquo;s absence</li><li>
Provides subject-matter expertise on complex or escalated hotline inquiries and investigations involving utility services, electric, gas, telecommunications, water, and household goods</li><li>
Conduct detailed research and data analysis to support case resolution, policy evaluation, and program evaluation</li><li>
Deliver benchmarking insights and performance comparisons to utility company leadership</li><li>
Perform on-site inspections and audits of utility companies; interview stakeholders to identify and address customer service concerns</li><li>
Monitor utility customer service operations, programs, and compliance activities</li><li>
Prepares confidential correspondence and analytical reports containing statistics and findings that support recommendations for corrective action to the company and PUCO leadership</li><li><p>
Advise utility companies on the Commission's interpretation of rules, regulations, and non-compliance violations</p></li></ul><p></p><p><b><br>
Report in location:</b> 180 E. Broad St., Columbus, Ohio 43215, Franklin County.</p><p></p><p><br>
** <b>This is a customer service position that does not involve law enforcement investigations</b></p><p><b>
Our organization currently follows a hybrid work structure where employees can work remotely or from the office as needed and based on operational need. This is subject to change with limited notice. A teleworking agreement must be approved by management</b></p><p></p><p><i><br>
PUCO core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across PUCO departments. Most positions perform work on-site at the PUCO Central Office. The PUCO offers flextime work schedules that allow an employee to start the day as early as 6:00am or as late as 10:30am. Flex-time schedules are based on operational need and require supervisor approval.</i></p><p><b><i>
Salary Information:</i></b><i> Unless required by legislation or union contract, starting salary is set at the lowest rate of the salary range. In most cases, successful employees will increase a step in the salary range within six months, with subsequent step increases occurring every year. In addition, the State of Ohio offers cost of living adjustments, longevity supplements after five years of public service, and wellness incentives.</i></p><p></p><b><br>
Why Work for the State of Ohio</b><p>
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:</p>
<ul>
<li>Medical Coverage</li>
<li>Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period</li>
<li>Paid time off, including vacation, personal, sick leave and 11 paid holidays per year</li>
<li>Childbirth, Adoption, and Foster Care leave</li>
<li>Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)</li>
<li>Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) &amp; Optional Deferred Compensation (Ohio Deferred Compensation)</li>
</ul>
<ul><li>Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.</li></ul><b>
Qualifications</b><div>
30 mos. trg. or 30 mos. investigative exp. with experience corresponding to type of complaints &amp; alleged violations appearing in job posting/approved position description; valid driver's license.
<br>
<br>
<ul><li>Or Completion of associate core program in law enforcement, criminal justice or in academic field commensurate with program area to be assigned per approved Position Description on file; 12 mos. exp. conducting investigations &amp;/or inspections; valid driver&rsquo;s license.
</li></ul><br>
<ul><li>Or 30 mos. trg. or 30 mos. exp. as Investigator Assistant, 26210 with experience corresponding to type of complaints &amp; alleged violations appearing in job posting/approved position description; valid driver's license.
</li></ul><br>
<ul><li>Or equivalent of Minimum Class Qualifications for Employment noted above.
</li></ul><br>
<b>Job Skills:</b> Investigation
</div><b>Supplemental Information</b><p>
Applications must clearly indicate how the applicant meets the minimum qualifications for the position. All answers to the supplemental questions must be supported by information provided in the work experience and/or education sections on your application. If you have attached supporting documents in the past, you must make them relevant on your current application. If you do not demonstrate how you meet minimum qualifications in the application, your application may be disqualified from consideration. Answering the supplement questions does not prove you meet the minimum qualifications.</p><b>
ADA Statement</b><p>
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.</p><b>
Drug-Free Workplace</b><p>
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.</p></div></div>

Lead Customer Service Investigator (Investigator)

Devoted Health

<div></div><div><div>Job Description</div><div><i>
A bit about this role:</i></div><div></div><div>
Are you a highly analytical and experienced investigator with a passion for uncovering the truth and protecting vital healthcare resources? Our Special Investigations Unit (SIU) is looking for a skilled Investigator to join our dedicated team. In this crucial role, you'll be at the forefront of preventing, detecting, and responding to healthcare fraud, waste, and abuse (FWA), safeguarding our members and the integrity of the Medicare Fund. If you're driven by meticulous investigation, data-driven insights, and a commitment to justice, we encourage you to apply.</div><div></div><div><i>
Responsibilities and Impact will include:</i></div><div><br>
As an SIU Investigator, you'll be responsible for the full lifecycle of complex FWA investigations, acting as a subject matter expert and collaborating with various stakeholders. Your key responsibilities will include:</div><ul><li><div>
Lead Complex Investigations: Plan, organize, and execute specialized investigations into allegations of healthcare fraud, waste, and abuse. This includes handling intricate cases requiring advanced investigative knowledge and skills.</div></li><li><div>
Data-Driven Detection: Utilize advanced data mining and analysis techniques to identify aberrancies and outliers in claims, medical records, enrollment, and other healthcare transactions. You'll independently research FWA issues and employ cutting-edge investigative resources.</div></li><li><div>
Expert Guidance: Serve as a subject matter expert for other SIU Investigators, providing specialized knowledge and guidance to elevate team capabilities.</div></li><li><div>
Policy &amp; Strategy Development: Contribute to the development of robust policies and procedures related to FWA detection and investigation, as well as the annual SIU risk assessment and work plan.</div></li><li><div>
Thorough Documentation &amp; Reporting: Conduct comprehensive FWA investigations, ensuring complete and accurate case documentation and detailed investigative reports that adhere to SIU policies and standards.</div></li><li><div>
External Referrals &amp; Collaboration: Prepare comprehensive summary and detailed reports on investigative findings for referral to federal and state agencies, ensuring full compliance with regulatory requirements. You'll also actively participate in OIG Healthcare Fraud Workgroups.</div></li><li><div>
Stakeholder Engagement: Collaborate closely with internal stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing Committee) to share updates on FWA schemes, coordinate recommendations, and facilitate fund recovery or other necessary actions.</div></li><li><div>
Provider Education: Conduct impactful provider education sessions as a direct response to investigation findings and audits.</div></li><li><div>
Liaison &amp; Point of Contact: Serve as a key point of contact for corporate and field inquiries regarding FWA, and participate in meetings with providers, business partners, regulatory agencies, and law enforcement.</div></li><li><div>
Training &amp; Development: Assist in developing and presenting engaging FWA training programs for internal and external audiences.</div></li></ul><div></div><div><i>
Required skills and experience:</i></div><ul><li><div>
Education: A Bachelor&rsquo;s Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent relevant work experience.</div></li><li><div>
Experience:</div></li></ul><ul><li><div>
Minimum of 3 years of dedicated experience in health insurance fraud investigation.</div></li><li><div>
Minimum of 5+ years experience as a detective or investigator for a law enforcement agency.</div></li><li><div>
Proven experience within Medicare and/or Medicaid programs, specifically with medical claim billing, reimbursement, audit, or provider contracting.</div></li><li><div>
Demonstrated experience with data analysis techniques.</div></li><li><div>
Experience with the Healthcare Fraud Shield platform is a significant plus.</div></li></ul><ul><li><div>
Exceptional Analytical Skills: Ability to interpret and dissect complex data sets, identifying patterns and anomalies indicative of FWA. Must have demonstrated experience with AI tools.</div></li><li><div>
Outstanding Communication: Excellent written and verbal communication skills are essential for clear report writing, compelling presentations, and effective stakeholder engagement.</div></li><li><div>
Integrity &amp; Detail-Oriented: A strong commitment to integrity and compliance, coupled with meticulous attention to detail in all aspects of investigations.</div></li><li><div>
Independent &amp; Collaborative: Proven ability to work independently, manage a diverse caseload of investigations, and thrive in a fast-paced environment, while also excelling in collaborative team settings.</div></li><li><div>
Strong Organizational Skills: Highly organized with the ability to manage multiple complex investigations simultaneously and effectively prioritize tasks.</div></li></ul><div></div><div><i>
Desired skills and experience:</i></div><ul><li><div>
Certified Fraud Examiner (CFE)</div></li><li><div>
Certified Professional Coder (CPC)</div></li></ul><div></div><div><br>
#LI-DS1<br>
#LI-Remote<br>
<br>
Salary range: $55,000 - $100,000 /year</div><div></div><div>
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.</div><div></div><div>
Our Total Rewards package includes:</div><ul><li><div>
Employer sponsored health, dental and vision plan with low or no premium</div></li><li><div>
Generous paid time off</div></li><li><div>
$100 monthly mobile or internet stipend</div></li><li><div>
Stock options for all employees</div></li><li><div>
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles</div></li><li><div>
Parental leave program</div></li><li><div>
401K program</div></li><li><div>
And more....</div></li></ul><div></div><ul><li><i>Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.</i></li></ul><div></div><div>
Healthcare equality is at the center of Devoted&rsquo;s mission to treat our members like family. We are committed to a diverse and vibrant workforce.</div><div></div><div>
At Devoted Health, we&rsquo;re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That&rsquo;s why we&rsquo;re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company &mdash; one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!</div><div></div><div>
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted&rsquo;s Code of Conduct, our company values and the way we do business.</div><div></div><div>
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.</div></div>
<br><p></p><div><div><div><div><div><div>We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for &ldquo;start up costs&rdquo; or &ldquo;equipment&rdquo;), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.</div></div></div></div></div></div><div></div>

SIU Investigator

PrimeWest Health

<p>Ready to be the ultimate fraud fighter? If you have a nose for the truth and a passion for protecting healthcare resources, PrimeWest Health needs your investigative expertise!<br/>As our SIU Investigator, you aren't just filing reports&mdash;you&rsquo;re the front line against fraud, waste, and abuse. You&rsquo;ll dive deep into Medicare and Medicaid business lines, turning raw data and initial allegations into rock-solid cases. From the first spark of suspicion to the final referral to law enforcement, you own the investigation.<br/>Why this role kicks it up a notch:<br/>The Lead Detective: You are the organization&rsquo;s primary resource for all things investigative.<br/>Total Case Ownership: You&rsquo;ll identify, develop, and resolve cases, managing everything from high-stakes evidence collection to complex data analysis.<br/>Collaborative Impact: You&rsquo;ll work side-by-side with internal teams, county partners, and external agencies to stop noncompliance in its tracks.<br/>Strategic Influence: Support the Corporate Compliance/HIPAA Privacy Officer by providing the subject matter expertise needed to keep our program integrity ironclad.<br/></p><p>Education &amp; Experience: Bachelor&rsquo;s degree in Business or a related field (preferred); equivalent experience in healthcare compliance, fraud investigation, auditing, or medical coding is also accepted.<br/></p><p>Experience: Proven background in healthcare investigations, medical record auditing, provider profiling, or program integrity&mdash;ideally within a health plan or regulatory agency.<br/>Technical Knowledge: Proficiency with CPT, HCPCS, and ICD-10 code sets.<br/>Tech Savvy: Strong Microsoft Office skills required; experience with claims processing or data systems is a major plus.<br/></p><p>Core Competencies<br/></p><p>Investigative Skills: Ability to independently research complex issues, analyze data, and manage multiple investigations simultaneously.<br/>Analytical Thinking: Strong problem-solving, negotiation, and conflict-resolution skills.<br/>Compliance Expertise: Ability to interpret and implement healthcare compliance guidelines and regulatory requirements.<br/>Communication: Excellent verbal and written skills to present complex findings clearly to diverse audiences.<br/>Professional Standards<br/>Attention to Detail: Exceptional organizational skills and a commitment to maintaining strict confidentiality.<br/>Judgment: Proven ability to exercise sound, independent judgment in sensitive situations.<br/>Work Ethic: Adaptable to evolving tasks, willing to learn new skills, and committed to meeting deadlines.<br/>Physical &amp; Travel Requirements<br/>Ability to work at a computer for extended periods, occasionally lift up to 20 lbs, and travel as needed.<br/></p><p>Why You&rsquo;ll Love Working Here:<br/></p><p>Comprehensive Benefits &ndash; Medical, dental, and vision coverage.<br/>Generous Paid Time Off &ndash; Vacation, sick, holidays, and personal days.<br/>Pension-Public Employee Retirement Association (PERA)<br/>Professional Growth &ndash; On-the-job training and development opportunities.<br/>Work-Life Balance &ndash; Regular business hours and a positive team culture.<br/>Onsite Fitness Center<br/></p><p>If you&rsquo;re a subject matter expert who loves solving puzzles and ensuring corrective actions stick, it&rsquo;s time to bring your skills to a team that values integrity as much as you do.<br/></p><p>Ready to protect the integrity of PrimeWest Health? Apply today!<br/></p>

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