Senior Investigator, Investigations Unit

CareOregon

Senior Investigator managing advanced FWA duties and investigations for CareOregon's health plan operations. Developing effective programs to prevent and rectify fraud, waste, and abuse issues.

Posted 7/2/2026full-timeRemote • Oregon, Washington • 🇺🇸 United StatesSenior💰 $92,070 - $112,530 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced expertise in administering fraud, waste, and abuse (FWA) programs, ensuring compliance with CMS requirements and Federal Sentencing Guidelines. Proficient in conducting investigations, preparing reports, and educating staff on FWA regulations.

Highest-signal resume keywords

Fraud, Waste, And Abuse ManagementCompliance And Audit ExperienceCPC CertificationMedicaid And Medicare KnowledgeFraud Investigations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud InvestigationsFWA ReportingData VerificationAudit Findings PreparationRegulatory Compliance

Soft Skills

CoachingCommunicationLeadership

Certifications & Qualifications

CPCRHITCFE

Industry Keywords

CMS RequirementsFederal Sentencing GuidelinesMedicaidMedicare

About the role

Key responsibilities & impact

Administer the fraud, waste, and abuse (FWA) duties at an advanced level
Ensure effective measures are in place and operating effectively to prevent, detect, and correct fraud, waste, and abuse
Perform advanced level of fraud investigations and provide regular FWA reporting to regulatory agencies
Help ensure that appropriate procedures are in place and followed consistently to safeguard assets, verify accuracy and reliability of data, and promote efficient operations
Contribute to the development and operation of an effective FWA program in accordance with CMS requirements and Federal Sentencing Guidelines
Prepare reports of audit findings and recommendations
Educate and coach leaders and staff regarding FWA requirements and complex issues
Participate in completing required Medicare and Medicaid filings and/or responses for FWA

Requirements

What you’ll need

Minimum 5 years’ experience in compliance and/or audit
Minimum 1 year experience focused on fraud, waste, and abuse
CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner) Preferred
Fraud, waste and abuse experience in Medicaid or Medicare

Benefits

Comp & perks

Health insurance
Dental insurance
Vision insurance
Life insurance
AD&D insurance
Disability insurance
Health savings account
Flexible spending account(s)
Lifestyle spending account
Employee assistance program
Wellness program
Discounts
Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
Strong retirement plan with employer contributions
Paid time off (PTO)
Paid State Sick Time
Paid holidays
Volunteer time
Jury duty
Bereavement leave