special crimes investigator

L.A. Care Health Plan

<div></div><div><div><div><div><div><div><div><p>Special Investigation Unit Investigator III
</p></div></div></div></div><div><div><div><div><b>Job Category: </b>Administrative, HR, Business Professionals
</div></div></div></div><div><div><div><div><b>Department: </b>Special Investigations Unit
</div></div></div></div><div><div><div><div><b>Location:
</b>Los Angeles, CA, US, 90017
</div></div></div></div><div><div><div><div><b>Position Type: </b>Full Time
</div></div></div></div><div><div><div><div><b>Requisition ID: </b>13060
</div></div></div></div><div><div><div><div><div><b>Salary Range:</b> $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)</div><br>
<div></div>
<div>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation&rsquo;s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br>
<br>
Mission: L.A. Care&rsquo;s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br>
</div><div><div><div><div>Job Summary</div>
</div><div><p>
The Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud &amp; abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste &amp; abuse. In addition, this position is responsible for building the investigative approach and provide leadership for Investigators through mentoring, on-site audit leadership and hands-on training of investigative techniques.</p><br>
<p></p>
<div>Responsible for in-depth investigations requiring subject matter expertise for suspected provider, pharmacy, employer or member fraud or abuse across all products at L.A. Care Health Plan. Ensures adherence to L.A. Care's policies and procedures for its various product offerings. Conducts investigation-related training. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</div>
</div></div><div><div><div>
Duties</div>
</div><div><p>
Investigates allegations and complex issues pertaining to potential health care fraud by providers or members. Makes potential fraud &amp; abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. Proactively seeks out and develops leads received from fraud tips and any variety of sources (e.g., fraud alerts, media) and initiates appropriate action. Writes comprehensive investigatory/fact-finding reports and summaries documenting interviews and findings. Reviews information contained in standard claims processing system files (e.g. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action. This position is a leader at onsite audits as assigned in conjunction with investigation development. Completes investigations after referrals to law enforcement (Department of Health Care Services (DHCS), Centers for Medicare &amp; Medicaid Services (CMS), Department of Justice (DOJ) or local police). Participates at hearings/appeals and can testify as a witness in court proceedings. Initiates the process with L.A. Care&rsquo;s Recovery Services for recoupment of overpaid monies.</p><br>
<p></p>
<p>Submits referrals of suspected fraud cases within mandated period of time as required by DHCS and CMS. Prepares and submits investigative report documenting all phases of an investigation. Compiles and maintains various documentation and other reporting requirements while following all confidentiality and security guidelines. Maintains cases referred to law enforcement and responds to requests for information; pursues applicable administrative actions during investigation/case development.</p><br>
<p></p><div>Participates in industry meetings/trainings and is able to effectively share and gather significant information. Develops and maintains strong working relationships with associates and regulators including DHCS, DOJ the FBI, Local Law Enforcement, Prosecutors, etc. Continually enhances investigative skills and understanding of emerging issues and trends impacting the industry.</div><br>
<div></div><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project&rsquo;s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><br>
<div></div>
<div>Perform other duties as assigned.</div>
</div></div><div><div><div>
Duties Continued</div>
</div></div><div></div><div><div><div>Education Required</div>
</div><div><div>Bachelor's Degree in Criminal Justice or Related Field</div><div>
In lieu of degree, equivalent education and/or experience may be considered.</div></div></div><div><div><div>
Education Preferred</div>
</div><div><div>Master's Degree in Criminal Justice or Related Field</div></div></div><div><div><div>
Experience</div>
</div><div><div><b>
Required:</b></div>
<p>Minimum of 5 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.</p>
<p>Experience conducting fact-finding interviews or investigations to gather information and draw conclusions from various accounts and versions of the same event.</p><br>
<p></p>
<p>Experience managing large amounts of data including pivot tables, complex calculations, and ability to perform comparisons across multiple large data sets</p><br>
<p></p>
<p><b>Preferred:
</b></p><div>Diverse experience as subject matter expert (SME) with multiple specialties including: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.</div>
</div></div><div><div><div>
Skills</div></div><div><div><br>
<b>Required:</b><br>
Excellent research skills and the ability to support conclusions with documentary evidence.</div><br>
<div></div>
<div>Excellent analytical, problem solving, and resolution skills and the ability to discern the practical application of regulatory and legal requirements.</div><br>
<div></div>
<div>Demonstrated strong organizational skills and the ability to manage multiple demands and priorities.</div><br>
<div></div>
<div>Excellent and effective communication skills, both verbal and written.</div><br>
<div></div>
<div>Proficient computer skills, including computer applications such as MS Word and Excel.</div><br>
<div></div>
<div>Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.</div><br>
<div></div>
<div>Ability to maintain in-depth working knowledge of fraud investigation techniques and mentor less experienced team members.</div><br>
<div></div>
<div><b>Preferred:
</b></div><div>Proficiency with Access.</div>
</div></div><div><div><div>
Licenses/Certifications Required</div>
</div></div><div></div><div><div><div>Licenses/Certifications Preferred</div>
</div><div><div>Accredited Health Care Fraud Investigator (AHFI)</div><div>
Certified Fraud Examiner (CFE)</div><div>
Certified Professional Coder (CPC) designation by the American Academy of Professional Coders</div></div></div><div><div><div>
Required Training</div>
</div></div><div></div><div><div><div>Physical Requirements</div>
</div><div><div>Light</div></div></div><div><div><div>
Additional Information</div>
</div></div></div><div></div><div><b>
Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.</div><br>
<div></div>
<div><b>L.A. Care offers a wide range of benefits including</b></div>
<ul><li>Paid Time Off (PTO)</li>
<li>Tuition Reimbursement</li>
<li>Retirement Plans</li>
<li>Medical, Dental and Vision</li>
<li>Wellness Program</li>
<li>Volunteer Time Off (VTO)</li></ul><div><br>
</div></div></div></div></div><p><br>
<b>Nearest Major Market: </b>Los Angeles
<br>
<b>Job Segment: </b>Medical Coding, Pharmacy, Behavioral Health, Clinic, Hospice, Healthcare</p></div></div></div><div></div>

Special Investigation Unit Investigator III

Department Of Family And Protective Services

<div><div>The Texas Department of Family and Protective Services (DFPS) works to build on strengths of families and communities to keep children and vulnerable adults safe, so they thrive. We do this through investigations, services, and referrals.</div><div></div><div><b><br>
What You Get Beyond Your Paycheck</b></div><div>
When you join the State of Texas, your monthly paycheck is just one part of your real income. Our benefits provide extra value that many private employers simply don&rsquo;t match&mdash;often adding hundreds of dollars each month to what you take home or save.</div><div></div><div><br>
Here&rsquo;s what you get as a full-time employee:</div><ul><li><b>
100% paid health insurance</b> for you, and 50% paid for eligible family members&mdash;saving you hundreds every month in out-of-pocket medical costs</li><li><b>
Retirement plans</b> with lifetime monthly payments after five years of state service, plus options to save even more with 401(k) and 457 plans</li><li><b>
Paid vacation, holidays, and sick leave</b> so you can recharge and take care of life outside work (that&rsquo;s time off you&rsquo;re actually paid for)</li><li><b>
Optional dental, vision, and life insurance</b>&mdash;at rates much lower than most private plans</li><li><b>
Flexible spending accounts</b> for added tax savings on health and dependent care</li><li><b>
Employee discounts</b> on things like gym memberships, electronics, and entertainment</li></ul><div></div><div><br>
You also might qualify for Public Service Loan Forgiveness, which could help you pay off federal student loans faster.</div><div>
You can see all the details here: ERS recruitment brochure</div><p></p><p><b><br>
Functional Title: </b>CPI Special Investigator Trainee<br>
<b>Job Title: </b>CPI SI Investigator III<br>
<b>Agency: </b>Dept of Family &amp; Protectve Svc<br>
<b>Department: </b>Special Investigations<br>
<b>Posting Number: </b>16814<br>
<b>Closing Date: </b>07/07/2026<br>
<b>Posting Audience: </b>Internal and External<br>
<b>Occupational Category: </b>Protective Services<br>
<b>Salary Range: </b>$4,748.95<b> </b>- $5,921.25<br>
<b>Pay Frequency: </b>Monthly<br>
<b>Salary Group: </b>TEXAS-B-18<br>
<b>Shift: </b>Day<br>
<b>Additional Shift:</b><br>
<b>Telework: </b>Not Eligible for Telework<br>
<b>Travel: </b>Up to 75%<br>
<b>Regular/Temporary: </b>Regular<br>
<b>Full Time/Part Time: </b>Full time<br>
<b>FLSA Exempt/Non-Exempt:</b> Nonexempt<br>
<b>Facility Location:</b>
<br>
<b>Job Location City:</b> FORT WORTH<br>
<b>Job Location Address:</b> 2270 MALL CIR.<br>
<b>Other Locations:</b> Fort Worth; Arlington; Bedford; Hurst; Lake Worth<br>
<b>MOS Codes:</b> 5805,5813,5819,5821,5822,7596,8012,14N,14NX,183X,1D7X1,1N0X1,1S0X1,250X,311A,31A,31B,31D,31PX,351L<br>
351M,35A,35L,35M,3E7X1,3P0X1,43HX,4B0X1,4E0X1,5I0,649X,683X,71SX,749X,783X,89D,89E,EOD,INV,IS,IV,LN<br>
MA,ME,MLES,MSSD,MSSE,MSSR,MST,OAP12,OAP14</p><br>
<div>
CPI Special Investigator Trainee</div><div><br>
</div><div><b>Brief Job Description:</b></div><p>
IMPORTANT NOTICE: This is a specialized position requiring previous experience as a police officer. This is not an entry-level opportunity.<br>
<br>
Professional Background: Only candidates with a solid background in investigative roles within law enforcement will be considered for this position.<br>
<br>
OVERVIEW<br>
Work involves investigating cases that are of a high profile or high-risk and may require a joint investigation with local law enforcement due to alleged criminal acts. Assists the Department of Family and Protective Services (DFPS) Investigation Supervisors by providing consultation and assistance to the investigation of complex cases. Provide forensic investigation techniques and investigation skills. Accompanies DFPS staff on investigations and provides information on criminal statutes, law enforcement procedures, and legal issues when circumstances warrant. Provides feedback to DFPS staff on effective investigation techniques from a law enforcement perspective, may carry a small caseload within the unit, provides training to and serves as a consultant to DFPS staff. Interacts routinely with DFPS staff, supervisors, clients, law enforcement professionals, medical professionals, legal professionals and others involved in the investigative process. Attends civil and criminal court proceedings as required.</p><p>
HELP US MAKE A DIFFERENCE:</p><p>
To explore more of what Investigation Specialists do, click here.</p><div>
For a realistic job preview of this position and to learn more DFPS, please click here. You will also have access to a self-assessment that will help you determine if this type of work is something that is a good fit for you.</div><div></div><div><b><br>
Essential Job Functions (EJFs):</b></div><ul><li>
Conducts specialized investigations of child abuse and neglect, as required by management.</li><li>
Serves as a resource and trainer to DFPS Staff on forensic interview skills and techniques.</li><li>
Identifies and provides for staff development and training needs in the area of forensic child abuse and neglect investigation to achieve and enhance quality performance of unit staff.</li><li>
Provides expert consultation to DFPS staff and the community on complex issues associated with forensic child abuse and neglect investigations.</li><li>
Conducts in-depth interviews to accurately obtain information to determine immediate or long-term risk of abuse or neglect; models advanced interviewing techniques for other workers.</li><li>
Assesses family dynamics and functioning to determine degree and type of agency intervention needed.</li><li>
Prepares and provides sufficient case documentation (including forms and narratives) to provide a complete and accurate record on cases, including legal documentation or testifying in court for all necessary court cases.</li><li>
Reviews cases identified by Child Safety Specialists for specific risk factors or assistance with forensic investigation techniques, in order to ensure staff develop and implement appropriate casework actions and case plans.</li><li>
Attends training and participates in professional development as required by agency and/or supervisor.</li><li>
Performs other duties as assigned and required to maintain unit operations.</li><li>
Promotes and demonstrates appropriate respect for cultural diversity among coworkers and all work-related contacts.</li><li>
Attends work regularly in accordance with agency leave policy.
</li><li>Develops and maintains communication and working relationships within and outside the agency, particularly with professionals associated with law enforcement investigations.</li></ul><div><b>
Knowledge, Skills and Abilities (KSAs):</b></div><div>
Supervisor will determine appropriate knowledge, skills and abilities.</div><br>
<div></div><ul><li>
Knowledge of Texas criminal and civil law relating to abuse and neglect of children.</li><li>
Knowledge of forensic interviewing techniques.</li><li>
Knowledge of normal child development and family dynamics, including problem areas of domestic violence, substance abuse, criminal activity.</li><li>
Knowledge of community resources, particularly within the law enforcement community, and their use for addressing child abuse and neglect problems.</li><li>
Skill in forensic interviewing of children and adults.</li><li>
Skill in determining risk of harm to children.</li><li>
Skill in applying crisis intervention techniques.</li><li>
Skill in investigating and resolving difficult child abuse or neglect cases.<br>
Skill in verbal and written communication.</li><li>
Ability to establish and maintain effective working relationships with employees, agency staff, law enforcement personnel and community stakeholders.</li><li>
Ability to evaluate investigation records in relation to the department standards for quality.</li><li>
Ability to analyze reports and produce comprehensive documents regarding findings.</li><li>
Ability to train staff in forensic interview techniques.</li></ul><div><br>
</div><div><b>Registrations, Licensure Requirements or Certifications:</b></div><p>
Valid Texas Driver's License</p><p>
TCOLE Intermediate License, out of state Peace Officer license, Federal Law Enforcement Officer Certification or Military experience comparable to Texas Peace Officer.</p><p>
Preferred:</p><p>
A current, Licensed Texas Peace Officer or have been a licensed Peace Officer in the State of Texas in the past two years.</p><p>
TCOLE Advance or Master Peace Officer License or equivalent from an out of state law enforcement agency or the United States Military.
</p><div>Out of state law enforcement agency, Federal Law Enforcement Agency or United State Military licenses and certifications comparable to a Texas Peace Officer are acceptable.</div><div><br>
</div><p><b>Initial Criteria:</b></p><ul><li>
Graduation from an accredited high school or equivalent.</li><li>
Five years as a TCOLE Licensed Peace Officer (or comparable out-of-state/military/federal certification).</li></ul><p><b>
OR</b></p><ul><li>
Three years as a TCOLE Licensed Peace Officer (or comparable out-of-state/military/federal certification), <b>AND</b> 2 years&rsquo; experience in DFPS Child Protection Investigations <b>OR</b> completion of DFPS Special Investigator training during previous DFPS employment.</li><li><ul><li>
Experience acquired through military police or military criminal investigative service (e.g., Army MOS 31B/31D, Marine Corps 5811/5821, Navy MA, Air Force 3P0X1/7S0X1, or equivalent) will be considered qualifying experience for all the above criteria, where applicable.</li></ul></li><li><b>
Preferred:</b> 60 hours college credit; 2 years as a Detective/Investigator with multidisciplinary teams on child abuse/neglect or similar. Experience using forensic investigation skills (interviewing suspects, collecting evidence, obtaining statements, report writing).</li></ul><p>
This position may be filled at a CPI Senior Investigator Trainee or a CPI Senior Investigator III. Factors such as education and experience may be considered when determining the classification to be used for hire.</p><p><b>
Additional Information:</b></p><div>
Applicants selected for this position are also eligible to receive a $416.66 monthly increase in addition to the base salary. Applicants hired into an investigative position will receive this increase the first of the month following 120 days of tenure. Once employed, the incumbent must remain in an investigative position to continue to receive the additional pay. If you leave Family Investigations or AR and return within the last 12-months, the INV stipend is given immediately. All other situations must wait the 120 days to receive the INV stipend.</div><div></div><div><b><br>
For APS/CPI/CPS Caseworker positions:
</b></div><p>This role requires frequent travel to homes and offices both within and outside your assigned region. Reliable transportation and a strong willingness to travel are essential, as you can expect to be on the road about 60% of the time. While much of your travel will be local, there will be instances&mdash;including last-minute situations&mdash;where you&rsquo;ll need to go outside your assigned counties, sometimes with little notice. Some overnight travel is also required, especially during initial training held outside your area and as cases demand. Flexibility is critical, as our mission to protect the most vulnerable means you must be ready to serve clients wherever and whenever you are needed.</p><p></p><p><br>
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.</p><p>
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor&rsquo;s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions. You may also contact the DFPS Military Liaison at dfpsmilvets@dfps.texas.gov with additional questions.</p><p>
Applicants selected for hire must pass a background check and if applicable a driver&rsquo;s record check.</p><p>
State of Texas employees are required to maintain the security and integrity of critical infrastructure as defined in Section 117.001(2), State of Texas Business and Commerce Code. Applicants selected for hire comply with this code by completing related training and abiding by agency cybersecurity and communications system usage policies.</p><p>
As a state agency, DFPS is required by Texas Administrative Code (TAC 206 and 213) to ensure all Electronic Information Resources (EIR) follow accessibility standards. The staff must be familiar with the WCAG 2.1 AA and Section 508 to create accessible content including but not limited to; Microsoft Office documents, Adobe PDFs, webpages, software, training guides, video, and audio files.</p><p>
DFPS uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Employees must provide documentation to DFPS to show their identity and authorization to work in the US. Please review the following link for authorized documents: https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents .</p><p>
In compliance with the Americans with Disabilities Act (ADA), HHS/DFPS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS/DFPS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.</p></div>

CPI Special Investigator Trainee

U.S. Secret Service

<div>
 <strong>
  Recruitment Incentive: Applicants may be eligible for a $40,000 recruitment incentive in accordance with regulatory requirements. Click apply for complete details on the recruitment incentive details and eligibility.
  <br/>
  <br/>
 </strong>
 <strong>
  At their core, those who join the Secret Service are courageous, intelligent, strong and determined. A diverse team capable of balancing our investigative mission and fulfilling our protective legacy. Proven to be worthy of trust and confidence. Be tomorrow's Secret Service.
  <br/>
  <br/>
 </strong>
 <strong>
  Duties
  <br/>
  <br/>
 </strong>
 During the course of their careers, special agents carry out assignments in both investigations and protection and may be assigned to multiple duty stations throughout the U.S. and abroad. Duties include:
 <br/>
 <br/>
 <ul>
  <li>
   Providing protection for various protectees.
  </li>
  <li>
   Conducting criminal investigations pertaining to financial obligations of the United States.
  </li>
  <li>
   Planning and implementing security designs for National Special Security Events.
   <br/>
   <br/>
  </li>
 </ul>
 This is no ordinary job, and our special agents are no ordinary individuals. Show us you have the talent and background we need, and we'll show you the rewards that come with being a special agent in the U.S. Secret Service. We invite you to become part of our elite team. Explore a career that will take you to new heights while you serve your country with honor, distinction and pride.
 <br/>
 <br/>
 <strong>
  Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   U.S. citizenship is required
  </li>
  <li>
   Possess a current valid driver's license
  </li>
  <li>
   Carry and use a firearm. Maintaining firearm proficiency is mandatory.
  </li>
  <li>
   Be at least age 21 at the time of application and less than age 37 at the time you receive a conditional offer of employment, unless you have previous service in a Federal Civilian Law Enforcement position covered by special law enforcement or firefighter retirement provisions, including early or mandatory retirement. Applicants with veteran's preference must receive a conditional offer of employment prior to reaching age 40 to continue in the application process.
  </li>
  <li>
   You must obtain a Top Secret Clearance and retain it during your career.
  </li>
  <li>
   Possess uncorrected visual acuity of no worse than 20/100 binocular, possess corrected visual acuity of 20/20 or better in each eye.
  </li>
  <li>
   Hearing loss, as measured by an audiometer, must not exceed 25 decibels (A.S.A. or equivalent I.S.O.) in either ear in the 500,1000 and 2000Hz ranges.
  </li>
  <li>
   Submit to a drug test prior to your appointment and random drug testing while you occupy the position.
  </li>
  <li>
   Complete 13 weeks of intensive training at the Federal Law Enforcement Training Center(FLETC) in Glynco, GA and 18 weeks of specialized training at the James J. Rowley Training Center in Laurel, MD.
  </li>
  <li>
   Sign a mobility agreement stating your willingness to accept assignments anywhere within the United States and overseas.
  </li>
  <li>
   Certify that you have registered with the Selective Service System or are exempt from having to do so, if you are a male applicant born after December 31, 1959.
  </li>
 </ul>
</div>


Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

Search 6778+ Special crimes investigator jobs near you this May. New roles added regularly across leading industries. Apply today.

6778 special crimes investigator jobs Near Me

Special Investigation Unit Investigator III

CPI Special Investigator Trainee

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive