Detectives and Criminal Investigators

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

**Job Posting Title**

SIU Investigator - Remote

**Job Description**

The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential member, and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively identifies improvement opportunities in audit and investigation procedures and FWA prevention efforts ensure proper identification of potential FWA. The SIU Investigator prepares investigative reports for leadership, remediation actions, recovery efforts, internal committees and/or referral to state and federal law enforcement agencies.

**Responsibilities**

+ Develop investigative plans, documents and justification to support investigations; evaluate impact of changing circumstances or newly discovered evidence to a previously developed investigation plan; proactively communicate plans, progress and changes to department leadership and other internal or external stakeholders

+ Evaluate reports of potential fraud in SIU and make recommendations on next steps; ensure investigative action aligns to department policy and practice; provide recommendations to audit operations and/or SIU regarding enhancements or required changes to process

+ Adhere to evidentiary requirements in compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with investigations based on the allegations, quality metrics and other performance indicators required per SIU procedures

+ Recommend referrals to client SIUs, regulatory agencies, and/or law enforcement; recommend retention of experts or private investigators, surveillance or other expenditures to support investigations

+ Other duties as assigned

**Education & Experience**

+ Bachelor of Science/Arts in Criminal Justice, Healthcare or related area of study or the equivalent combination of education and relevant work experience; HS diploma or GED is required

+ 2 years of work experience in investigation, audit or legal to include 1 year of work experience in data or crime analysis

Must be eligible to work in the United States without need for work visa or residency sponsorship

**Additional Qualifications**

+ Change agile; willing and able to adjust individual and team direction based upon changing priorities and business need while working with a high degree of autonomy

+ Ability to think critically, problem solve and use appropriate judgement to make decisions and provide risk advice to internal and external partners while anticipating the broad impact of decisions

+ Ability to establish trust, respect and credibility and form effective working relationships with individuals at all levels of an organization; collaborate effectively cross-functionally and with clients, law enforcement and other key stakeholders

+ Ability to distill complex concepts or situations into concise and compelling communications

+ Ability to interact positively and professionally during all member, prescriber and pharmacy interactions and effectively de-escalate potentially confrontational situations

**Preferred Qualifications**

+ Certified Fraud Examiner or Accredited Health Care Fraud Investigator

+ National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)

+ Licensed Practical Nurse (LPN) or Registered Nurse (RN)

+ Prior experience in a special investigation unit

+ Knowledge and understanding of pharmacy and medical claims processing environment

**Physical Demands**

+ Constantly required to sit, use hands to handle or feel, talk and hear

+ Frequently required to reach with hands and arms

+ Occasionally required to stand, walk and stoop, kneel, and crouch

+ Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

+ Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $28.37 - $45.19 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. _

_We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law._

_Prime Therapeutics LLC is a Tobacco-Free Workplace employer._

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.

Location: Anywhere in Country

At EY, you’ll have the chance to build a career as unique as you are, with the global scale, support, inclusive culture and technology to become the best version of you. And we’re counting on your unique voice and perspective to help EY become even better. Join us and build an exceptional experience for yourself, and a better working world for all.

The exceptional EY experience. It's yours to build.

EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.

**Job description**

At EY, you’ll have the chance to build a career as unique as you are, with the global scale, support, inclusive culture and technology to become the best version of you. And we’re counting on your unique voice and perspective to help EY become even better, too. Join us and build an exceptional experience for yourself, and a better working world for all.

**The opportunity**

The Ethics and Compliance Investigations Team Assistant Director works as part of the centralized Ethics and Compliance Investigations Team to conduct and manage Code of Conduct related investigations. They will work closely with Ethics, Compliance, and Risk Management (ECRM) leaders to implement investigation strategies and programs, and Talent and/or GCO on individual matters. The position is responsible for addressing and resolving complex employee and Partner, Principal, Managing Director, and Director inquiries from start to finish on a wide range of investigation and Code of Conduct topics.

**Your key responsibilities**

+ Manage and conduct Code of Conduct related investigations as assigned

+ Lead interviews of all relevant persons

+ Maintain and track investigation and status in a centralized database

+ Follow documentation and reporting standards

+ Draft memorandum summarizing factual conclusions

+ Maintain strict confidentiality

+ Conduct detailed reporting and analysis to inform stakeholders and identify trends and root causes

+ May participate in intake analysis to determine appropriate disposition of inquiries

+ May present findings to firm leadership, as necessary

+ Make recommendations for trainings, awareness, communications, and more

+ May lead and/or participate in medium to large projects

+ Share best practices and mentor others

+ May supervise and/or mentor other team members

**Decision Making Responsibilities**

You will be responsible for interpreting highly sensitive data related to Code of Conduct related concerns, including potential policy violations. You will also assess situations to determine risk mitigation and escalate as necessary to appropriate parties (e.g., ECRM, General Counsel Office, or Talent).

**Knowledge and Skills Requirements**

+ Experience conducting investigations

+ Ability to analyze and synthesize high volumes of information to reach factual conclusions

+ Strong writing skills, ideally including investigative summary memos or other legal documents

+ Strong interviewing skills

+ Knowledge of applicable employment law & practices

+ Ability to interact with individuals at all levels within the firm

+ Maintains professionalism and confidentiality

+ Solid project and time management and ability to coordinate multiple projects simultaneously

+ Attention to detail

+ Ability to quickly learn the business of the firm

+ Ability to influence multiple constituents

+ Solid networking skills and the ability to build relationships

+ Solid understanding of internal practices and procedures

**To qualify for this role, you must have**

+ Ability to interact with individuals at all levels within the firm and maintain professionalism and confidentiality

+ Strong attention to detail, time management and prioritization skills, with solid track record of managing multiple projects/cases simultaneously

+ Excellent written communication skills and an ability to convey complex facts, perspectives, and conclusions in a way that’s clear to any audience; experience with legal writing preferred

+ Strong interviewing skills, investigative interviewing a plus

+ Ability to influence multiple constituents and engage in respectful dialogue in cases of disagreement

+ Solid networking skills and the ability to build relationships

+ Works independently on recurring projects but is not afraid to seek guidance or consult with colleagues for alternative views/suggestions

+ Bachelor’s degree or equivalent work experience; Master’s degree preferred

+ 7+ years related work experience

**Ideally, you’ll also have**

May have Society for Human Resource Management (SHRM) certification, Certified Fraud Examiner (ACFE) certification, or similar investigatory certification, but not required

**Other Requirements**

+ Experience: 7+ years related work experience

+ Education: Bachelor’s degree or equivalent work experience. Advanced degree preferred

+ Travel may be required

**What we offer**

We offer a competitive compensation package where you’ll be rewarded based on your performance and recognized for the value you bring to our business. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options. Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances, as long as it aligns with business needs/expectations. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.

+ Continuous learning: You’ll develop the mindset and skills to navigate whatever comes next.

+ Success as defined by you: We’ll provide the tools and flexibility, so you can make a meaningful impact, your way.

+ Transformative leadership: We’ll give you the insights, coaching and confidence to be the leader the world needs.

+ Diverse and inclusive culture: You’ll be embraced for who you are and empowered to use your voice to help others find theirs

If you can demonstrate that you meet the criteria above, please contact us as soon as possible.

The exceptional EY experience. It’s yours to build.

**What we offer**

We offer a comprehensive compensation and benefits package where you’ll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $100,000 to $187,000. The salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is $120,000 to $212,500. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options. Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year. Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.

+ **Continuous learning:** You’ll develop the mindset and skills to navigate whatever comes next.

+ **Success as defined by you:** We’ll provide the tools and flexibility, so you can make a meaningful impact, your way.

+ **Transformative leadership:** We’ll give you the insights, coaching and confidence to be the leader the world needs.

+ **Diverse and inclusive culture:** You’ll be embraced for who you are and empowered to use your voice to help others find theirs.

EY accepts applications for this position on an on-going basis. **If you can demonstrate that you meet the criteria above, please contact us as soon as possible.**

EY exists to build a better working world, helping to create long-term value for clients, people and society and build trust in the capital markets.

Enabled by data and technology, diverse EY teams in over 150 countries provide trust through assurance and help clients grow, transform and operate.

Working across assurance, consulting, law, strategy, tax and transactions, EY teams ask better questions to find new answers for the complex issues facing our world today.

For those living in California, please click here (https://ey-preview.ey.com/content/ey-unified-site/ey-com/local/us/en\_us/home/legal-and-privacy/fair-chance-ordinance.html?token=68cf9ed2-94e5-4db9-83cf-5c6aa14619de) for additional information.

EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law.

EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY’s Talent Shared Services Team (TSS) or email the TSS at ssc.customersupport@ey.com .

Location: Anywhere in Country

At EY, you’ll have the chance to build a career as unique as you are, with the global scale, support, inclusive culture and technology to become the best version of you. And we’re counting on your unique voice and perspective to help EY become even better. Join us and build an exceptional experience for yourself, and a better working world for all.

The exceptional EY experience. It's yours to build.

EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.

**Job description**

At EY, you’ll have the chance to build a career as unique as you are, with the global scale, support, inclusive culture and technology to become the best version of you. And we’re counting on your unique voice and perspective to help EY become even better, too. Join us and build an exceptional experience for yourself, and a better working world for all.

**The opportunity**

The Ethics and Compliance Investigations Team Assistant Director works as part of the centralized Ethics and Compliance Investigations Team to conduct and manage Code of Conduct related investigations. They will work closely with Ethics, Compliance, and Risk Management (ECRM) leaders to implement investigation strategies and programs, and Talent and/or GCO on individual matters. The position is responsible for addressing and resolving complex employee and Partner, Principal, Managing Director, and Director inquiries from start to finish on a wide range of investigation and Code of Conduct topics.

**Your key responsibilities**

+ Manage and conduct Code of Conduct related investigations as assigned

+ Lead interviews of all relevant persons

+ Maintain and track investigation and status in a centralized database

+ Follow documentation and reporting standards

+ Draft memorandum summarizing factual conclusions

+ Maintain strict confidentiality

+ Conduct detailed reporting and analysis to inform stakeholders and identify trends and root causes

+ May participate in intake analysis to determine appropriate disposition of inquiries

+ May present findings to firm leadership, as necessary

+ Make recommendations for trainings, awareness, communications, and more

+ May lead and/or participate in medium to large projects

+ Share best practices and mentor others

+ May supervise and/or mentor other team members

**Decision Making Responsibilities**

You will be responsible for interpreting highly sensitive data related to Code of Conduct related concerns, including potential policy violations. You will also assess situations to determine risk mitigation and escalate as necessary to appropriate parties (e.g., ECRM, General Counsel Office, or Talent).

**Knowledge and Skills Requirements**

+ Experience conducting investigations

+ Ability to analyze and synthesize high volumes of information to reach factual conclusions

+ Strong writing skills, ideally including investigative summary memos or other legal documents

+ Strong interviewing skills

+ Knowledge of applicable employment law & practices

+ Ability to interact with individuals at all levels within the firm

+ Maintains professionalism and confidentiality

+ Solid project and time management and ability to coordinate multiple projects simultaneously

+ Attention to detail

+ Ability to quickly learn the business of the firm

+ Ability to influence multiple constituents

+ Solid networking skills and the ability to build relationships

+ Solid understanding of internal practices and procedures

**To qualify for this role, you must have**

+ Ability to interact with individuals at all levels within the firm and maintain professionalism and confidentiality

+ Strong attention to detail, time management and prioritization skills, with solid track record of managing multiple projects/cases simultaneously

+ Excellent written communication skills and an ability to convey complex facts, perspectives, and conclusions in a way that’s clear to any audience; experience with legal writing preferred

+ Strong interviewing skills, investigative interviewing a plus

+ Ability to influence multiple constituents and engage in respectful dialogue in cases of disagreement

+ Solid networking skills and the ability to build relationships

+ Works independently on recurring projects but is not afraid to seek guidance or consult with colleagues for alternative views/suggestions

+ Bachelor’s degree or equivalent work experience; Master’s degree preferred

+ 7+ years related work experience

**Ideally, you’ll also have**

May have Society for Human Resource Management (SHRM) certification, Certified Fraud Examiner (ACFE) certification, or similar investigatory certification, but not required

**Other Requirements**

+ Experience: 7+ years related work experience

+ Education: Bachelor’s degree or equivalent work experience. Advanced degree preferred

+ Travel may be required

**What we offer**

We offer a competitive compensation package where you’ll be rewarded based on your performance and recognized for the value you bring to our business. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options. Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances, as long as it aligns with business needs/expectations. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.

+ Continuous learning: You’ll develop the mindset and skills to navigate whatever comes next.

+ Success as defined by you: We’ll provide the tools and flexibility, so you can make a meaningful impact, your way.

+ Transformative leadership: We’ll give you the insights, coaching and confidence to be the leader the world needs.

+ Diverse and inclusive culture: You’ll be embraced for who you are and empowered to use your voice to help others find theirs

If you can demonstrate that you meet the criteria above, please contact us as soon as possible.

The exceptional EY experience. It’s yours to build.

**What we offer**

We offer a comprehensive compensation and benefits package where you’ll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $100,000 to $187,000. The salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is $120,000 to $212,500. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options. Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year. Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.

+ **Continuous learning:** You’ll develop the mindset and skills to navigate whatever comes next.

+ **Success as defined by you:** We’ll provide the tools and flexibility, so you can make a meaningful impact, your way.

+ **Transformative leadership:** We’ll give you the insights, coaching and confidence to be the leader the world needs.

+ **Diverse and inclusive culture:** You’ll be embraced for who you are and empowered to use your voice to help others find theirs.

EY accepts applications for this position on an on-going basis. **If you can demonstrate that you meet the criteria above, please contact us as soon as possible.**

EY exists to build a better working world, helping to create long-term value for clients, people and society and build trust in the capital markets.

Enabled by data and technology, diverse EY teams in over 150 countries provide trust through assurance and help clients grow, transform and operate.

Working across assurance, consulting, law, strategy, tax and transactions, EY teams ask better questions to find new answers for the complex issues facing our world today.

For those living in California, please click here (https://ey-preview.ey.com/content/ey-unified-site/ey-com/local/us/en\_us/home/legal-and-privacy/fair-chance-ordinance.html?token=68cf9ed2-94e5-4db9-83cf-5c6aa14619de) for additional information.

EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law.

EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY’s Talent Shared Services Team (TSS) or email the TSS at ssc.customersupport@ey.com .