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Investigator, Special Investigative Unit Coding (Remote)

Hckd Fa Us2 Oraclecloud Com CX 1 · United States; Remote Employees, Long Beach, CA, US · Remote · Active · Oracle Recruiting Cloud / Fusion HCM

Job facts

FieldValue
CompanyHckd Fa Us2 Oraclecloud Com CX 1
TitleInvestigator, Special Investigative Unit Coding (Remote)
Normalized title-
Department / teamLegal, Risk, & Compliance
LocationUnited States
Work modelRemote / Remote
Employment typeFull Time
Salary-
Statusactive
ATS providerOracle Recruiting Cloud / Fusion HCM
Posted / first seen2026-04-30 / 2026-05-31
Changed / last seen2026-05-31 / 2026-06-06

Related slices

PageWhat it containsOpen
Company jobsActive postings from Hckd Fa Us2 Oraclecloud Com CX 1.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through Oracle Recruiting Cloud / Fusion HCM.Open
Provider filtered searchThe same provider as a filtered job collection.Open
Department jobsActive postings in Legal, Risk, & Compliance.Open
Work model jobsActive Remote postings.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

CompanyHckd Fa Us2 Oraclecloud Com CX 1
Source8214b818-efda-4f30-9713-cac0e888e0f9
ATS providerOracle Recruiting Cloud / Fusion HCM

Description

Description JOB DESCRIPTION Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims. Essential Job Duties Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies. Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments. Manages documents and prioritizes caseloads to ensure timely turnaround. Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements. Devises clinical summary post-review. Communicates and participates in meetings related to cases. Completes medical review to facilitate referral to law enforcement or payment recovery. Supports investigation work as necessary and required by the regulatory agency. Job Requirements At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience. Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified Critical-thinking, problem-solving and analytical skills. Ability to prioritize and manage multiple tasks. Ability to work in a team setting. Strong verbal/written communication skills, and presentation skills. Microsoft Office suite (including Excel), and applicable software program(s) proficiency. In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements). Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs. Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. Ability to research and interpret regulatory requirements. Preferred Qualifications Certified Professional Compliance Officer (CPCO). Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI). Experience working in group health insurance, particularly within claims processing or operations. Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). Experience with claims processing systems. Ability to use Microsoft Excel/Access platforms working with large quantities of data. Ability to answer questions, identify trends and patterns, and present findings. #PJCorp #LI-AC1 To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Full job record

Job ID2272eea57dd91dd9461f8d8e5ab0609b55d91433
Org ID6fcfe228-ec8c-4e31-bf8d-2e5d2cb49f0a
Source ID8214b818-efda-4f30-9713-cac0e888e0f9
Board ID8214b818-efda-4f30-9713-cac0e888e0f9
Provideroracle_hcm
Provider Job Key2037329
TitleInvestigator, Special Investigative Unit Coding (Remote)
Normalized Title
Statusactive
Activeyes
Location TextUnited States; Remote Employees, Long Beach, CA, US
DepartmentLegal, Risk, & Compliance
Team
Employment Typefull_time
Workplace Typeremote
Remote Policyremote
CountryUnited States
Region
City
Salary RawDescription JOB DESCRIPTION Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims. Essential Job Duties Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies. Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments. Manages documents and prioritizes caseloads to ensure timely turnaround. Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements. Devises clinical summary post-review. Communicates and participates in meetings related to cases. Completes medical review to facilitate referral to law enforcement or payment recovery. Supports investigation work as necessary and required by the regulatory agency. Job Requirements At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience. Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified Critical-thinking, problem-solving and analytical skills. Ability to prioritize and manage multiple tasks. Ability to work in a team setting. Strong verbal/written communication skills, and presentation skills. Microsoft Office suite (including Excel), and applicable software program(s) proficiency. In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements). Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs. Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. Ability to research and interpret regulatory requirements. Preferred Qualifications Certified Professional Compliance Officer (CPCO). Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI). Experience working in group health insurance, particularly within claims processing or operations. Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). Experience with claims processing systems. Ability to use Microsoft Excel/Access platforms working with large quantities of data. Ability to answer questions, identify trends and patterns, and present findings. #PJCorp #LI-AC1 To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Salary Min
Salary Max
Salary Currency
Salary Period
Source URLhttps://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037329
Apply URLhttps://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037329
First Seen At2026-05-31 18:03:56Z
Last Seen At2026-06-06 11:30:43Z
Last Checked At2026-06-06 11:30:43Z
Last Changed At2026-05-31 18:03:56Z
Inactive At
Source Posted At2026-04-30 15:54:10Z
Source Updated At
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=oracle_hcm/board=hckd.fa.us2.oraclecloud.com|CX_1/date=2026-06-06/2026-06-06T11-30-00-878Z-5a444c553533de92339bc7e174bf6b5a8b1de72b0bf53453749588ed04e6f9bf.json
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