Fire Inspectors and Investigators

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

The Special Investigations Unit is seeking a Manager to lead our team of Certified Professional Coders (CPC).

The Manager is responsible for overseeing and managing coding reviews for fraud detection, investigation, and prevention efforts to safeguard the organization’s resources and reduce healthcare costs. This role involves leading a team of CPC’s, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops strategies to manage workload, quality of reviews and process improvements.

**Responsibilities:**

Lead and mentor a team certified coders who support fraud detection and prevention efforts.

Establish team goals, monitor performance, and ensure alignment with organizational objectives.

Direct and oversee complex reviews.

Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action.

Conducts team member evaluations and provides performance feedback to staff on an ongoing basis.

Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs

Confirm staff are preparing comprehensive reports summarizing investigation outcomes.

Ensure findings comply with state, federal, and industry regulations.

Stay informed about changes in the industry practices related to healthcare coding.

Provide training opportunities for staff to maintain their CEUs.

Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries.

**Required Qualifications:**

Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing

In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.

Proficient in researching information and identifying information resources

AAPC Coding certification - Certified Professional Coder (CPC)

Strong leadership and team management ability

Excellent communication and presentation skills.

Ability to work cross-functionally with various teams and external partners.

Ability to travel for business needs.

**Preferred Qualifications:**

Registered Nurse (RN)

Previous leadership experience.

AAPC Coding Certification – Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC)

Licensed Clinical Social Worker (LCSW)

Licensed Independent Social Worker (LISW)

Licensed Master Social Worker (LMSW)

**Education**

Bachelor, Associates Degree or work equivalent

Certification as a Certified Professional Coder (CPC)

**Pay Range**

The typical pay range for this role is:

$54,300.00 - $159,120.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 02/28/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Summary As a Supervisory Equal Opportunity Investigator at the GS-1860-13, you will be part of Phoenix District Office, Equal Employment Opportunity Commission. If selected, you will provide guidance and direction to a staff of investigators, investigative support assistants and other support staff. You will also be responsible for the full range of enforcement functions associated with the investigative work of the unit. Responsibilities Supervises and provides substantive technical and administrative guidance to a staff of investigators, investigator support assistants, and clerical personnel. Reviews investigative files on an ongoing basis to ensure proper application of the theories of employment discrimination laws and that sufficient information is being requested and/or has been obtained. Assures that staff adheres to all EEOC guidelines, rules, regulations, orders, and precedents in the daily performances and completion of investigative duties and administrative functions. Participates with higher level managers in establishing procedures to ensure achievement of District and agency goals and objectives and recommends changes in investigative and operational procedures to meet Agency's mission. Participates on management review teams, in special program review projects, in special investigative efforts, and in the design, development and delivery of internal or external program training. Requirements Conditions of Employment Qualifications For the GS-13: You must have at least one year of specialized experience equivalent to the GS-12 level in the Federal service. Specialized experience includes experience analyzing, researching, and evaluating employment discrimination laws, regulations, or policies; planning and establishing priorities; and conducting investigations of employment discrimination. Applicants must meet all eligibility requirements within 30 days of the closing date specified in the vacancy announcement. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Education This position does not have an education qualification requirement. Additional Information Relocation expenses will not be paid. You will be expected to report to the duty station listed on this announcement. This job opportunity announcement may be used to fill additional similar vacancies across EEOC. If you are unable to apply online or need to fax a document that you do not have in electronic form, please refer to the agency contact information. If you are a veteran and you are claiming 5-point veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility. If you are a veteran and you are claiming 10-point veterans' preference, you must also submit an SF-15, "Application for 10-Point Veterans' Preference" plus the proof required by that form. For more information on veterans' preference (see https://www.fedshirevets.gov/job-seekers/veterans-preference/#content). Males born after 12-31-59 must be registered or exempt from Selective Service (see: https://www.sss.gov/Home/Registration) All employees of the Federal government are subject to the conflict of interest statutes and regulations including the Standards of Ethical Conduct that govern activities with outside organizations and reporting financial holdings. This position may require the incumbent to complete a confidential financial disclosure report within 30 days of appointment.

Summary As a Supervisory Equal Opportunity Investigator at the GS-1860-13, you will be part of Phoenix District Office, Equal Employment Opportunity Commission. If selected, you will provide guidance and direction to a staff of investigators, investigative support assistants and other support staff. You will also be responsible for the full range of enforcement functions associated with the investigative work of the unit. Responsibilities Supervises and provides substantive technical and administrative guidance to a staff of investigators, investigator support assistants, and clerical personnel. Reviews investigative files on an ongoing basis to ensure proper application of the theories of employment discrimination laws and that sufficient information is being requested and/or has been obtained. Assures that staff adheres to all EEOC guidelines, rules, regulations, orders, and precedents in the daily performances and completion of investigative duties and administrative functions. Participates with higher level managers in establishing procedures to ensure achievement of District and agency goals and objectives and recommends changes in investigative and operational procedures to meet Agency's mission. Participates on management review teams, in special program review projects, in special investigative efforts, and in the design, development and delivery of internal or external program training. Requirements Conditions of Employment Qualifications For the GS-13: You must have at least one year of specialized experience equivalent to the GS-12 level in the Federal service. Specialized experience includes experience analyzing, researching, and evaluating employment discrimination laws, regulations, or policies; planning and establishing priorities; and conducting investigations of employment discrimination. Merit promotion applicants must meet time-in-grade requirement as defined in 5 CFR 300, Subpart F. One year at the GS-12 level is required to meet the time-in-grade requirements for the GS- 13 level. Applicants must meet all eligibility requirements (e.g., time-in-grade and qualification requirements) within 30 days of the closing date specified in the vacancy announcement. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Education This position does not have an education qualification requirement. Additional Information Relocation expenses will not be paid. You will be expected to report to the duty station listed on this announcement. This job opportunity announcement may be used to fill additional similar vacancies across EEOC. If you are unable to apply online or need to fax a document that you do not have in electronic form, please refer to the agency contact information. Veterans Employment Opportunity Act (VEOA): To be eligible for a VEOA appointment under Merit Promotion procedures, the veteran must be a preference eligible or a veteran separated after 3 years or more of continuous active service performed under honorable conditions. Noncompetitive Appointment Authorities: For more information on noncompetitive appointment authority eligibility requirements visit the following websites: Persons with Disabilities, Schedule A Special Hiring Authorities for Veterans Special Hiring Authorities for Certain Military Spouses Family of overseas employees Peace Corps & AmeriCorps VISTA Foreign Service Employees Males born after 12-31-59 must be registered or exempt from Selective Service (see: https://www.sss.gov/Home/Registration) All employees of the Federal government are subject to the conflict of interest statutes and regulations including the Standards of Ethical Conduct that govern activities with outside organizations and reporting financial holdings. This position may require the incumbent to complete a confidential financial disclosure report within 30 days of appointment.

Every day at Disney Cruise Line we take pride in bringing the magic of Disney to life. We find joy in creating cherished memories and form genuine connections with our guests. We hold each other to the highest degree and always act responsibly while ensuring the safety of fellow crew and guests. United by our Disney values, we work toward excellence in all we do. As a part of our team, you can live and work in a diverse and inclusive environment amidst a professional and supportive community. If you are ready to create unforgettable experiences and grow as a person and as a professional, apply today.

As Ship Investigation Manager, maintain through exemplary leadership Disney Cruise Line® security criminal investigation operations at the highest standards. Coordinate with the security teams onboard for investigation and make recommendations to shore side management in respect to improving security investigation operations. Verify that the operational parameters of the company security criminal investigation philosophies are maintained.

You will report to Company Security Officer

Level: 3 stripes Officer

**Responsibilities :**

+ Verifying that security criminal investigations are compliant with the Ship Security Plan and Disney Cruise Line® policies and procedures

+ Conduct and control all shipboard criminal investigations, and prepare relevant reports

+ Create timeline of investigative incidents

+ Conduct video analysis of security investigations

+ Liaise and cooperate with shore side law enforcement and security agencies

+ Complete proper evidence gathering, securing, disposal, and documentation of same

+ Oversee crime scene preservation

+ Proactively develop actionable intelligence regarding guest and crew behavior

+ Interface with other ship departments to develop and share intelligence

+ Conduct crew policy violations (CPVs) of a criminal nature; assist with non-criminal CPVs

+ Conduct and memorialize investigation related interviews

+ Assist with non-criminal accident/injury investigations, when available

+ Ongoing review and development of security investigations policies and procedures

+ Training the security team regarding investigations and crime scene and evidence preservation.

+ Mentoring of subordinate by providing the knowledge, skills, and encouragement to foster personal and professional growth.

+ Identifying and developing training opportunities.

+ Communicating with the Shore Side Security Team to verify policy consistency throughout the fleet, where possible.

+ Provides professional and social guidance to subordinates by exemplary personal behavior.

+ Coordinate with Ship Security Officer and Chief Security Officer for all shipboard investigations

**Basic Qualifications :**

+ 10 years Law Enforcement/Military investigative experience

+ Skilled in Criminal Investigation Timeline creation

+ Demonstrated Intelligence gathering techniques

+ Excellent report writing

+ Court and legal case management and preparation of legal cases

+ Skilled in interview techniques

+ Skilled with video analytics

+ Demonstrated interpersonal skills and team building

+ Skilled in multiple reporting systems

**Additional Information :**

This is a **SHIPBOARD** role.

Applicants must:

+ Be genuinely interested in a career at sea and willing to live and work onboard a Disney Cruise Line vessel

+ Be committed to the position you are applying for at least 2-3 contracts before a transfer or promotion

+ Be willing to follow and perform safety role, emergency duties and/or associated responsibilities as specified in the ship Assembly Plan

+ Be willing and able to uphold the general safety management responsibilities specified in the Safety Management System in areas and operations under their control

+ Be willing to follow and embrace United States Public Health requirements and guidelines as well as Environmentality requirements and Company practices

+ Be willing to be appreciative of working and living in a multi-cultural environment

+ Be comfortable living in a confined space with strict rules and regulations

+ Adhere to a structured lifestyle, personally and professionally

Your Responsibilities:

+ Have a valid passport and C1/D Seaman's visa (DCL will provide you with documents to obtain this)

+ Complete a pre-employment medical

+ Obtain a criminal background check

**Disney Cruise Line is a drug-free workplace. All new hires are required to undergo drug/alcohol testing within the first week onboard and throughout their contracts. Failure to pass the drug/alcohol testing will result in immediate termination.

**Job ID:** 1249906BR

**Location:** United States

**Job Posting Company:** "Disney Cruise Line"

The Walt Disney Company and its Affiliated Companies are Equal Employment Opportunity employers and welcome all job seekers including individuals with disabilities and veterans with disabilities. If you have a disability and believe you need a reasonable accommodation in order to search for a job opening or apply for a position, email [email protected] with your request. This email address is not for general employment inquiries or correspondence. We will only respond to those requests that are related to the accessibility of the online application system due to a disability.

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

**Position Summary**

The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends.

Activities include:

- Conduct a comprehensive medical record review to ensure billing is consistent with medical record.

- Provide detailed written summary of medical record review findings.

- Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.

- Review and discuss cases with Medical Directors to validate decisions.

- Assist with investigative research related to coding questions, state and federal policies.

- Identify potential billing errors, abuse, and fraud.

- Identify opportunities for savings related to potential cases which may warrant a prepayment review.

- Maintain appropriate records, files, documentation, etc.

- Ability to travel for meetings and potential to testify

**Required Qualifications**

- AAPC Coding certification - Certified Professional Coder (CPC)

- 3+ years of experience in medical coding or documentation auditing.

- Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements

- Experience with researching coding, state regulations and policies.

- Working experience with Microsoft Excel

- Strong attention to detail and ability to review and interpret data

- Excellent communication skills

**Preferred Qualifications**

- 2 years or more previous experience with Behavioral Health coding/auditing of records

- Licensed Clinical Social Worker (LCSW)

- Licensed Independent Social Worker (LISW)

- Licensed Master Social Worker (LMSW)

- Prior auditing experience

- Excellent analytical skills

**Education**

- GED or equivalent

- AAPC Certified Professional Coder Certification (CPC)

**Pay Range**

The typical pay range for this role is:

$43,888.00 - $102,081.60

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 01/02/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

**Brief Overview**

As a Manager, Investigations - FEP MQA for CVS Health, you will Manage and optimize operational processes within healthcare organizations by developing and implementing strategic initiatives, analyzing data to drive process improvements, collaborating with cross-functional teams, and providing guidance and mentorship to junior staff. You will Enhance operational efficiency, ensure compliance with regulatory standards, and contribute to the overall success of healthcare operations.

**What you will do**

+ Oversee and manage investigations related to fraud, waste, and abuse within the Federal Employee Program (FEP) Member Quality Assurance (MQA) department.

+ Lead efforts to detect and investigate instances of fraud and abuse within the FEP MQ program.

+ Develop and implement proactive measures, such as data analytics, claims reviews, and other investigative techniques, to identify suspicious patterns or practices that may indicate fraudulent activities.

+ Assist in the development of investigation plans and strategies to effectively address potential fraud or abuse cases.

+ Collaborate with various internal departments, such as legal, compliance, claims, and provider relations, to ensure a coordinated approach to FEP MQA investigations.

+ Ensure quality documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information to facilitate transparency.

+ Coach an investigation team through the documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information.

+ Manage team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

+ Contribute to the development and enhancement of policies, procedures, and protocols related to FEP MQA investigations.

To be a candidate for this role, you will possess the following:

+ Adept at problem solving and decision making skills.

+ Adept at collaboration and teamwork.

+ Adept at growth mindset (agility and developing yourself and others) skills.

+ Adept at execution and delivery (planning, delivering, and supporting) skills.

_**This position is a remote position and candidates can live anywhere in the US, however it is preferred that candidates live in the_ _Phoenix Valley Metro area_ _and are able to come into the office 1 day per week.**_

**Required Qualifications**

+ 5 or more years of work experience.

+ Investigative work experience.

+ Experience managing multiple cases loads.

+ Experience training peers and presenting to leadership.

+ Experience/ Proficy with the Microsoft office suite.

**Preferred Qualifications**

+ Healthcare experience.

+ Pharmacy Benefit Manager (PBM) experience.

**Education**

+ Bachelor's degree required, may consider equivalent experience in lieu of a Bachelor's degree.

**Pay Range**

The typical pay range for this role is:

$54,300.00 - $119,340.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 01/19/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Summary The Office of the Inspector General is one of the best places to work in the Department of Justice and is one of the premier inspector general offices in federal government. The Investigations Division (INV) investigates alleged criminal violations and misconduct that govern DOJ employees, operations, grantees, and contractors. Annually INV receives more than 13,000 complaints, opens approximately 250 investigations, and makes an average of over 90 arrests. Responsibilities This position falls under the direction of the Investigations Division Tucson Office located in Tucson, AZ. If you are selected as a Criminal Investigator, your responsibilities would include, but would not be limited to: Analyzing initial allegations and recommending required investigative resources and collateral support. Investigating allegations of crime, crime scenes, and misconduct. Planning and conducting surveillance or undercover work. Apprehending and arresting persons violating U.S. laws and conducting search and seizure incident to the arrest or when appropriate by warrant. Preparing reports and presenting findings orally and in writing to managers, prosecutors, and other high-level officials. Testifying as a government witness before Grand Juries and in court regarding criminal cases. Testifying at administrative hearings in non-criminal cases. Requirements Conditions of Employment Qualifications To qualify for this position at the GS-13 grade level, you must have one year of specialized experience equivalent to the GS-12 grade level obtained in the public sector. (Specialized experience is paid or unpaid experience which has equipped you with the specific knowledge, skills, and abilities to successfully perform the duties of the position.) Examples of specialized experience include such duties as: the ability to conduct multi-jurisdictional and multi-defendant investigations relating to bribery, fraud, theft, abuse, violations of civil rights, conflicts of interest, and misconduct investigations. Experience must include undercover operations, surveillance assignments, search and seizure, issuing warrants, interrogations and making arrests. Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade level (or equivalent). Firearms: Criminal investigators are required to carry a firearm while performing duties of this position. Maintaining firearm proficiency is mandatory. Motor Vehicle Operation: You must possess a valid automobile driver's license at the time of appointment. Age: Applicants must be at least 21 years of age. The day immediately preceding an individual's 37th birthday will be the last day to be referred for selection consideration. However, the age restriction may not apply if you are a preference-eligible veteran or if you are currently serving or have previously served in a federal civilian law enforcement position covered by 5 U.S.C. § 8336(c) or 5 U.S.C. § 8412(d). Medical Examination: Individuals must meet the established medical standards and/or physical requirement for the position, proving they are medically and physically capable of performing the essential job functions and duties of the position safely and efficiently. A medical examination will be conducted. Any disease or condition that may potentially interfere with the safe and efficient performance of the job's duties or training may constitute grounds for medical disqualification. Medical qualification determinations will be made on a case-by-case basis. If additional medical information is recommended beyond that provided at the pre-employment examination, it is provided at the expense of the tentative selectee. Drug Testing: This job has been identified as "testing designated" under our Drug-Free Workplace Program. Therefore, you must satisfactorily complete a drug test prior to being hired. The agency will schedule, provide and pay for the drug test. Once on board, you will be subject to random drug testing. Law Enforcement Availability Pay (LEAP): As a law enforcement officer you will be required to work on an unscheduled basis in excess of the 40-hour work week. These positions require substantial overtime to include holidays, weekends and nights. You must be readily accessible to perform this unscheduled work. To ensure your availability, you will receive extra compensation in the form of Law Enforcement Availability Pay, which is calculated at a flat rate of 25 percent of base salary. Education There are no education requirements for this position. Additional Information The Career Transition Assistance Plan (CTAP)/Interagency Career Transition Assistance Plan (ICTAP). The CTAP/ICTAP provides eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. If your agency has notified you in writing that you are a displaced employee eligible for CTAP/ICTAP consideration, you may receive selection priority if: 1) this vacancy is within your CTAP/ICTAP eligibility; 2) you apply under the instructions in this announcement; and 3) you are found well-qualified for this vacancy. To be well qualified, you must satisfy all qualification requirements for the vacant position and (for scored examining) score 85 or better on established ranking criteria OR (for category rating criteria) rate equivalent to the Highly Qualified or better category using established category rating criteria. You must provide proof of eligibility with your application to receive selection priority. Such proof may include a copy of your written notification of CTAP/ICTAP eligibility or a copy of your separation personnel action form. Additional information about CTAP/ICTAP eligibility is at: www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. DOJ EEO Statement/Policy: http://www.justice.gov/jmd/eeos/08-eeo-policy.pdf As the federal agency whose mission is to ensure the fair and impartial administration of justice for all Americans, the Department of Justice is committed to fostering a diverse and inclusive work environment. To build and retain a workforce that reflects the diverse experiences and perspectives of the American people, we welcome applicants from the many communities, identities, races, ethnicities, backgrounds, abilities, religions, and cultures of the United States who share our commitment to public service. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable\_Accommodations\_for\_USA\_Hire Selective Service: If you are a male applicant born after December 31, 1959, you must certify that you have registered with the Selective Service System, or are exempt from having to do so under the Selective Service Law. Additional information is found at: www.sss.gov.

**JOB DESCRIPTION**

**Job Summary**

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

**KNOWLEDGE/SKILLS/ABILITIES**

+ Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.

+ Review of applicable policies, CPT guidelines, and provider contracts.

+ Devise clinical summary post review.

+ Communicate and participate in meetings related to cases.

+ Critical thinking, problem solving and analytical skills.

+ Ability to prioritize and manage multiple tasks.

+ Proven ability to work in a team setting.

+ Excellent oral and written communication skills and presentation skills.

**JOB QUALIFICATIONS**

**Required Education**

High School Diploma / GED (or higher)

**Required Experience**

+ 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location

+ Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)

**Required License, Certification, Association**

Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)

**Preferred Education**

Bachelor's degree (or higher)

**Preferred Experience**

+ 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.

+ A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)

+ Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.

+ Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.

**Preferred License, Certification, Association**

+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred

+ Certified Fraud Examiner and/or AHFI professional designations preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

As a Tier 1 Fraud Investigator, you will be joining our Converge Operations Team to be on the front lines protecting the retirement accounts of federal employees and members of the uniformed services. You will accomplish this by monitoring activity related to account takeover, identity theft, suspicious money movement or criminal violations across the Thrift Savings Plan (TSP). In addition to analyzing this activity, it is critical that you are accurate in your research and take appropriate actions to prevent, or otherwise mitigate any potential losses to protect our clients and our firm. Further, as the Technical Investigator, you will be responsible for addressing all fraud related technical matters, including data analytics and communicating technical issues to leadership.

Job Specific Skills:

+ Strong attention to detail and accuracy

+ Ability to analyze account data using critical thinking skills

+ Ability to effectively communicate with account holders by phone and email.

+ Ability to review online activity against IP data searches

+ Ability to respond to account holders reports of suspicious activity in a timely manner.

+ Ability to multitask and compare multiple data points

+ Ability to adapt to new processes or procedures

+ Exceptional problem solving and organizational skills

+ Excellent written and verbal communication skills

+ Proficiency in Microsoft Office programs

+ Excellent time management skills and diligent work ethic

**Minimum Qualifications**

+ High School Diploma or GED.

+ 2-5 years or related experience in Customer Service or public relations.

**Preferred Qualifications:**

+ Previous anti-fraud experience

+ Previous banking industry experience

**Other Job Specific Skills**

+ Excellent customer service skills.

+ Ability to provide effective customer service and deal tactfully and courteously with the public.

+ Strong commitment to providing quality service.

+ Strong attention to detail and accuracy.

+ Ability to convey enthusiasm, energy and sincerity over the phone.

+ Exceptional problem solving and organizational skills.

+ Ability to foster a good working relationship and rapport with customers.

+ Ability to adapt to new processes or procedures.

+ Ability to interact effectively with others

+ Excellent written and verbal communication skills.

**Compensation Ranges**

Compensation ranges for ASM Research positions vary depending on multiple factors; including but not limited to, location, skill set, level of education, certifications, client requirements, contract-specific affordability, government clearance and investigation level, and years of experience. The compensation displayed for this role is a general guideline based on these factors and is unique to each role. Monetary compensation is one component of ASM's overall compensation and benefits package for employees.

**EEO Requirements**

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, disability, or age. All decisions on employment are made to abide by the principle of equal employment.

Physical Requirements

The physical requirements described in "Knowledge, Skills and Abilities" above are representative of those which must be met by an employee to successfully perform the primary functions of this job. (For example, "light office duties' or "lifting up to 50 pounds" or "some travel" required.) Reasonable accommodations may be made to enable individuals with qualifying disabilities, who are otherwise qualified, to perform the primary functions.

**Disclaimer**

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

19.33-28.03

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, gender identity, veteran status, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, veteran status, disability, gender identity, or age. All decisions on employment are made to abide by the principle of equal employment.

At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive at every stage of your career. Try new things, learn new skills and discover what you excel at—all from Day One.

**Job Description**

Job Description

HR Advisory Services is hiring an HR Investigator to support . Investigators fact find on matters where concerns have been raised by employees and external customers to ensure that the Bank’s environment and employees live up to our Code of Conduct and Core Values, helping to ensure an ethical culture across the enterprise. Investigations include allegations of EEO behavior such as discrimination, harassment, retaliation as well as general misconduct.

As an Investigator you will be responsible for handling sensitive and challenging HR investigations. Your work will include investigating and resolving complex and urgent allegations, frequently on truncated timelines, and communicating effectively throughout a case with partners.

Investigators examine matters holistically and, where necessary, delve deeply into cases to ensure that root causes are determined and addressed. As a trusted partner, you will be expected to ensure that appropriate stakeholders are brought to the table to discuss the resolution and outcomes for current cases while proactively addressing conditions or problems that could cause situations to reoccur in the future. Understanding when and how these matters are escalated to stakeholders is critical. Investigators will be expected to think creatively and explore innovative solutions with partners across the organization.

Investigators skillfully conduct all facets of investigations, including conducting investigational interviews, writing summaries, and liaising with business line and HR partners.

Basic Qualifications

- Bachelor's degree in Business Administration, Human Resources Management, Industrial Relations, Psychology or related degree, or equivalent work experience

- Eight or more years of experience in employee relations or as an HR Generalist, or equivalent experience

Preferred Skills/Experience

- Diplomacy and executive communication skills; experience with influential authority

- Discretion and trustworthiness with highly sensitive matters

- Knowledge of and practical application of employment law in investigation situations

- Expertise in investigative interviews

- Flexibility and agility when demands and priorities shift

- Demonstrated resiliency and emotional intelligence in handling challenging situations and serious topics

- JD and/or advanced HR degrees/certifications a significant plus

If there’s anything we can do to accommodate a disability during any portion of the application or hiring process, please refer to our disability accommodations for applicants (https://careers.usbank.com/global/en/disability-accommodations-for-applicants) .

**Benefits:**

Our approach to benefits and total rewards considers our team members’ whole selves and what may be needed to thrive in and outside work. That's why our benefits are designed to help you and your family boost your health, protect your financial security and give you peace of mind. Our benefits include the following (some may vary based on role, location or hours):

+ Healthcare (medical, dental, vision)

+ Basic term and optional term life insurance

+ Short-term and long-term disability

+ Pregnancy disability and parental leave

+ 401(k) and employer-funded retirement plan

+ Paid vacation (from two to five weeks depending on salary grade and tenure)

+ Up to 11 paid holiday opportunities

+ Adoption assistance

+ Sick and Safe Leave accruals of one hour for every 30 worked, up to 80 hours per calendar year unless otherwise provided by law

**EEO is the Law**

U.S. Bank is an equal opportunity employer committed to creating a diverse workforce. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or veteran status, among other factors. Applicants can learn more about the company’s status as an equal opportunity employer by viewing the federal **KNOW YOUR RIGHTS (https://eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12ScreenRdr.pdf)** EEO poster.

**E-Verify**

U.S. Bank participates in the U.S. Department of Homeland Security E-Verify program in all facilities located in the United States and certain U.S. territories. The E-Verify program is an Internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. Learn more about the E-Verify program (https://careers.usbank.com/verification-of-eligibility-for-employment) .

The salary range reflects figures based on the primary location, which is listed first. The actual range for the role may differ based on the location of the role. In addition to salary, U.S. Bank offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase 401(k) contribution and pension (all benefits are subject to eligibility requirements). Pay Range: $119,765.00 - $140,900.00 - $154,990.00

U.S. Bank will consider qualified applicants with arrest or conviction records for employment. U.S. Bank conducts background checks consistent with applicable local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act as well as the San Francisco Fair Chance Ordinance. U.S. Bank is subject to, and conducts background checks consistent with the requirements of Section 19 of the Federal Deposit Insurance Act (FDIA). In addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures.

Applicants must be able to comply with U.S. Bank policies and procedures including the Code of Ethics and Business Conduct and related workplace conduct and safety policies.

Job postings typically remain open for approximately 20 days of the posting date listed above, however the job posting may be closed earlier should it be determined the position is no longer required due to business need. Job postings in areas with a high volume of applicants, such as customer service, contact center, and Financial Crimes investigations, remain open for approximately 5 days of the posting listed date.