Home › Companies › Hckd Fa Us2 Oraclecloud Com CX 1 › Investigator, Special Investigative Unit Coding (Remote)
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
| Field | Value |
|---|---|
| Company | Hckd Fa Us2 Oraclecloud Com CX 1 |
| Title | Investigator, Special Investigative Unit Coding (Remote) |
| Normalized title | - |
| Department / team | Legal, Risk, & Compliance |
| Location | United States |
| Work model | Remote / Remote |
| Employment type | Full Time |
| Salary | - |
| Status | active |
| ATS provider | Oracle Recruiting Cloud / Fusion HCM |
| Posted / first seen | 2026-04-30 / 2026-05-31 |
| Changed / last seen | 2026-05-31 / 2026-06-06 |
Related slices
| Page | What it contains | Open |
|---|---|---|
| Company jobs | Active postings from Hckd Fa Us2 Oraclecloud Com CX 1. | Open |
| Company breakdowns | Role, location, ATS, and work model facets for this company. | Open |
| ATS provider jobs | Active postings observed through Oracle Recruiting Cloud / Fusion HCM. | Open |
| Provider filtered search | The same provider as a filtered job collection. | Open |
| Department jobs | Active postings in Legal, Risk, & Compliance. | Open |
| Work model jobs | Active Remote postings. | Open |
| Lifecycle events | Open, update, close, and reopen events for this posting. | Open |
| Original posting | Canonical source or apply URL captured from the ATS. | Open |
Linked records
| Company | Hckd Fa Us2 Oraclecloud Com CX 1 |
| Source | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| ATS provider | Oracle 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 ID | 2272eea57dd91dd9461f8d8e5ab0609b55d91433 |
| Org ID | 6fcfe228-ec8c-4e31-bf8d-2e5d2cb49f0a |
| Source ID | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| Board ID | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| Provider | oracle_hcm |
| Provider Job Key | 2037329 |
| Title | Investigator, Special Investigative Unit Coding (Remote) |
| Normalized Title | — |
| Status | active |
| Active | yes |
| Location Text | United States; Remote Employees, Long Beach, CA, US |
| Department | Legal, Risk, & Compliance |
| Team | — |
| Employment Type | full_time |
| Workplace Type | remote |
| Remote Policy | remote |
| Country | United States |
| Region | — |
| City | — |
| Salary Raw | 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 |
| Salary Min | — |
| Salary Max | — |
| Salary Currency | — |
| Salary Period | — |
| Source URL | https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037329 |
| Apply URL | https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037329 |
| First Seen At | 2026-05-31 18:03:56Z |
| Last Seen At | 2026-06-06 11:30:43Z |
| Last Checked At | 2026-06-06 11:30:43Z |
| Last Changed At | 2026-05-31 18:03:56Z |
| Inactive At | — |
| Source Posted At | 2026-04-30 15:54:10Z |
| Source Updated At | — |
| Raw Payload Uri | s3://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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