Private Detectives and Investigators

Candidate must reside in the Phoenix area.

**Position Purpose:**

ORC Investigators (HDI-Home Depot Investigations) are responsible for the direction and support of Organized Retail Crime (ORC) investigations within a specified area of the company. ORC Investigators will work with various business partners (Corporate Security, dot com, RDO's, APM's and APS') and leverage all available investigative tools to eliminate and reduce company exposure to external theft. Key responsibilities include: analyzing information, determination of exception data to drive investigation, communication and coordination of information to field teams and other partners, management of the investigative process, coordination with law enforcement to ensure effective prosecution and restitution recovery, coordination with ORC Analysts to develop new exception data, management of remote CCTV viewing to support investigative efforts, and case trend analysis to drive performance and to make recommendations to mitigate theft exposure. ORC Investigators must be able to manage multiple tasks and to gain buy in and support of multiple partners to ensure a successful investigation process within their area of responsibility. ORC Investigators must be effective at training and coaching, as they will support the development of the investigative skill sets within their area of responsibility. ORC Investigators must have strong analytical and problem solving skills, as they will make recommendations to business partners for the elimination of procedural/policy issues that increase theft exposure. ORC Investigators will report directly to the Corporate ORC Manager(s) of HDI and will work in a collaborative team environment with the entire HDI Team.

**Key Responsibilities:**

+ 45% Case initiation /Gathering intelligence/ Field Tactics. Conducts various Field Tactics (i.e. static/mobile surveillance) to determine the scope of an investigation and help bring to resolution. Deploys Resources (Covert/Overt Surveillance Equipment, product tracking, etc.) under the partnership of the SSC Corporate ORC Manager(s). Utilize information from systems reports and databases to identify and communicate criminal activity impacting company assets. Gathers Intelligence internally and externally and presents to Law Enforcement for prosecution. Work with ORC Analyst to review all POS and Non POS exception report data to identify potential ORC Theft/Fraud issues within the assigned regions

+ 35% Case Management/Packaging and building cases. Updates Case Management System weekly. Develops detailed investigative plans to help bring cases to resolution at the appropriate scope and pace. Provides weekly updates to manager and AP Team within area of responsibility on case load and case management efforts. Thoroughly documents investigations and ensures proper video is retained for prosecution in the Case Management System.

+ 20% Networking and training with field teams, LE and retail. Represent THD during conferences and ORC meetings. Develop partnerships with SSC Leaders, Director, RDO's, APM's, and APS' to drive theft and fraud elimination. Maintain positive working relationships with AP Teams, Financial Institutions, Law Enforcement and peer Industry partners. Implementation of training and programs to prevent fraud and reduce loss potential.

**Direct Manager/Direct Reports:**

+ This position reports to Manager

+ This position has no Direct Reports

**Travel Requirements:**

+ Typically requires overnight travel less than 10% of the time.

**Physical Requirements:**

+ Frequent periods are spent standing or sitting in the same location with some opportunity to move about; occasionally there may be a need to stoop or lift light objects (typically less than 8 pounds).

**Working Conditions:**

+ Located in a comfortable indoor area. Any unpleasant conditions would be infrequent and not objectionable.

**Minimum Qualifications:**

+ Must be eighteen years of age or older.

+ Must be legally permitted to work in the United States.

**Preferred Qualifications:**

+ 5+ Years of Loss Prevention / Asset Protection Investigative experience

+ 2+ Years of Organized Retail Crime Investigative experience.

+ Competent in the use of retail CCTV systems.

+ Competent in the use of retail case management systems.

+ Loss Prevention Investigative Interview Training.

+ ORC certifications and/or training class completion

**Minimum Education:**

+ The knowledge, skills and abilities typically acquired through the completion of a high school diploma and/or GED.

**Preferred Education:**

+ No additional education

**Minimum Years of Work Experience:**

+ 3

**Preferred Years of Work Experience:**

+ No additional years of experience

**Minimum Leadership Experience:**

+ None

**Preferred Leadership Experience:**

+ None

**Certifications:**

+ None

**Competencies:**

+ None

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Apply End Date: 03/19/2025

- $0.00 - $0.00

Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our diverse and inclusive team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference. Enjoy comprehensive benefits for most full-time positions, including medical, dental, and vision coverage, life insurance, retirement plans, employee assistance programs, and exclusive perks.

Allied Universal® is hiring a Surveillance Investigator. The Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an Insurance claim.

+ **Opportunity awaits – apply now!**

+ **Job flexibility offering fieldwork!**

+ **Auto and travel allowances!**

**RESPONSIBILITIES:**

+ Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability

+ Utilize various surveillance techniques and equipment to monitor subjects covertly

+ Document and report observations, activities, and any relevant information in a clear and concise manner

+ Collaborate with other investigators and law enforcement agencies as needed to gather information and coordinate efforts

+ Maintain confidentiality and adhere to legal and ethical standards in conducting surveillance operations

**QUALIFICATIONS (MUST HAVE):**

+ High school diploma or equivalent

+ Post offer, must be able to successfully complete the Allied Universal Investigations' training/orientation course

+ Prior educational or professional exposure to witness interviews or video monitoring

+ Prior educational or professional incident reporting and/or investigations experience

+ Flexibility to work varied and irregular hours/days including weekends and holidays

+ Ability to type reports in Microsoft Word format with minimal grammatical and punctuation errors

+ Proficient in utilizing laptop computers, video cameras and cell phones

+ Capable of maintaining focus and multitasking effectively in a dynamic environment

+ Demonstrated ability to manage stressful situations with composure and professionalism

+ Ability to work in a very independent environment

**PREFERRED QUALIFICATIONS (NICE TO HAVE):**

+ Associate’s Degree or higher, preferably in Criminal Justice

+ Security/Loss Prevention experience

+ Military experience

+ Law enforcement experience

+ Prior insurance investigations experience

**BENEFITS:**

+ Medical, dental, vision, basic life, AD&D, and disability insurance

+ Enrollment in our company’s 401(k)plan, subject to eligibility requirements

+ Seven paid holidays annually, sick days available where required by law

+ Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law

**Allied Universal® is an Equal Opportunity Employer.** All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, have difficulty using the online system and require an alternate method to apply, or require an accommodation at any time during the recruitment and/or employment process, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices .

**Allied Universal® is an Equal Opportunity Employer.** All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, have difficulty using the online system and require an alternate method to apply, or require an accommodation at any time during the recruitment and/or employment process, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices .

**Job ID:** 2025-1352221

**Location:** United States-Arizona-Prescott Valley

**Job Category:** Compliance & Investigations

Command Investigations LLC is a dynamic and forward-thinking investigative company that has been at the forefront of the industry since its establishment in September of 2012. With a relentless commitment to excellence, we have consistently delivered top-tier investigative services to our clients, setting the standard for innovation and reliability in the field. Our seasoned team of professionals, coupled with cutting-edge technology and a customer-centric approach, has allowed us to stand out as a leader in the investigation industry. At Command Investigations, we take pride in our proven track record of providing comprehensive investigative solutions that empower our clients to make informed decisions. With over a decade of experience, we continue to push the boundaries of what's possible, setting the bar high for investigative excellence.

What you’ll get:

+ A dedicated position as a surveillance investigator.

+ A steppingstone into the realms of investigations, security, and law enforcement.

+ Immersion in the world of covert investigations.

+ A fulfilling career where each day brings a distinct adventure.

+ Prospects for career development within the organization.

+ The abilities you acquire here can open doors to careers in various fields, including the FBI, law enforcement, ATF, US Border Patrol, State Crime Lab, law-related roles, paralegal positions, legal assistant jobs, security, corporate investigations, and investigative journalism.

What you’ll need to apply:

+ Approximately 1 year experience relating to Work Compensation/Fraud/Mobile and Stationary surveillance

+ Hold a valid Private Investigator license – where applicable.

+ Possession of a high school diploma or GED.

+ Minimum age requirement of 21 years or older.

+ Readiness to travel and accommodate overnight stays for remote assignments when necessary.

+ Ability to utilize web-based technology, digital surveillance equipment and software.

+ Flexible availability to work any day of the week, weekends and holidays are required.

+ Capability to start work as early as 5:00 am daily, with occasional evening shifts.

+ Successful completion of DMV and background checks – must have valid Driver’s License.

+ Proficiency and confidence in driving skills.

+ Auto insurance – required liability limits must be 100k/300k/100k for Bodily injury per single person/Bodily injury per accident/Property damages.

What a day in the life of an investigator looks like:

+ Surveillance involves monitoring, tracking, and recording subjects during their daily routines.

+ Engaging in both vehicular and on-foot pursuits of subjects while maintaining covert operations.

+ Tasked with diverse activities, ranging from filming individuals at grocery stores to capturing their presence at a sporting event.

+ Developing pre-surveillance plans tailored to the location and case particulars.

+ Comprehensive report generation, detailing the observed and recorded activities, along with the submission of video evidence.

+ Consistent communication with the team leader regarding setup positions, ongoing activities, and tactical approaches.

Required Equipment: (Not Provided by Command Investigations)

+ A reliable vehicle with a dark tint (following state regulations).

+ Smartphone.

+ Laptop computer with Microsoft Word. (Windows or Mac)

+ Digital video camera (handheld camcorder) with upload capability and accurate time and date stamp.

+ Covert camera of choice.

Compensation:

+ Health, dental, vision, life insurance, PTO, 401(k)

+ Performance incentives

+ Biweekly pay

Benefits:

+ 401(k)

+ Dental insurance

+ Health insurance

+ Vision insurance

+ Life insurance

+ Paid time off

+ Referral program

+ Paid Travel Time

+ Paid Daily Vehicle Allowance

+ Paid Report Writing Time

+ Paid Training/Orientation

+ Reimbursement for various case related expenses

+ Overnight Pay

Schedule:

+ 10-hour shift

+ Holidays

+ Overtime

+ Weekends required

Work Location: Arizona -State Wide

Powered by JazzHR

**Job Summary**

Acts as liaison between Special Investigations Unit (SIU) operations and health plans and internal functional teams to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriate hand offs are adhered to, and the appropriate approvals and escalations are achieved. Coordinates with Associate Vice President, Special Investigations Unit, Regulatory Operations (AVP- SIU) within to oversee the special investigations unit development of multiple state and corporate antifraud plans and annual audit plans development policy and procedure maintenance and departmental compliance and implementation. Responsibilities may include responding to external audits, coordination of state readiness reviews, policy and procedures development, prepayment review oversight, regulatory reporting oversight, maintaining a schedule of active corrective action plans and follow-up activities. Additional support may include data mining and data analysis rules development, developing audit tools based on regulatory and contractual requirements, summarizing and approving investigations, resolving escalated disputes from providers, members, or related entities, documenting and/or conducting investigations of potential FWA or over payment allegations

**Essential Duties & Responsibilities**

• Creates and manages effective monitoring metrics to continually evaluate vendor contract requirements are met including quality, cost control, timeliness and business relations

• Assures an adequate quality assurance program and process are in place and strictly adhered to for all tasks

• Ensures that all turn-around-times and quality measurements are met

• Identifies improvement opportunities in protocols, and creates projects to address opportunity from root cause analysis through implementation

• Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to avoid duplication of efforts, assuring case statuses and disputes are appropriately resolved, assures timeliness of resolution, and assures referral compliance adherence

• Performs reviews of case files for sufficiency of content and documentation, approves and signs-off where appropriate

• Implements the most effective and efficient method of investigation for each FWA case and administers outcomes with vendor

• Tracks on budgeted recoveries, and initiates appropriate action plans to assure program stays on track

• Provides guidance to operational managers on the implementation and completion of resulting action plans

• Directs training for SIU unit personnel on internal and external protocols and systems and investigative techniques

• Oversees data mining and data analysis to identify outliers/potential fraud, waste, abuse and overpayments within overall payment integrity framework

• Strategizes with cross functional teams on payment integrity program advancements and best practice development

• Responsible to engage staff and drive high level of change management and business process transformation

• Represents the payment integrity area at key stakeholder internal and external meetings

• Capitalizes on opportunities to create pre-payment edits for recurring overpayment instances with cross functional teams, and drives cost avoidance measures

• Develops and maintains payment integrity policy and procedures, and ensures that all activities conform to the policy and procedures

• Evaluates the work of personnel and completes all required performance review documentation as applicable

• Performs special projects as requested by Leadership

• Attends professional conferences as assigned to ensure ongoing knowledge of regulatory guidance

• Maintains professional and technical knowledge through appropriate activities and ongoing learning

• Other duties as identified and assigned.

**Job Qualifications**

**Required Education**

• Bachelor's degree in a related field.

**Required Experience**

• Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law Enforcement or Risk Management

• Minimum 8-10 years leadership/supervisory experience required

• Progressive management experience to manage complex work systems and workflows required

• Knowledge of pre-edit and pre and post payment audit protocol, and payment integrity program protocols

• Excellent oral and written communication skills

• Strong organizational and leadership skills

• Strong independent decision making and critical thinking skills

• Strong negotiation, and conflict management skills

• Ability to succeed in a fast paced environment with evolving workflow and changing priorities

• Proficiency in Microsoft Access, Word and Excel

• Knowledge and understanding of claims processing systems and medical claims

• Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations

**Preferred Education**

• Master's degree

**Preferred Experience**

• Formalized training/experience in Health Care Insurance Fraud

• Experience with Power BI, SAS, SQL other reporting software

• ICD-9, ICD-10 CPT-4, HCPCS coding

**Preferred License, Certification, Association**

Professional certifications/accreditations, such as CFE, AHFI, HCAFA

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: $97,299 - $189,732 / ANNUAL

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

**Job Summary**

Acts as liaison between Special Investigations Unit (SIU) operations and health plans and internal functional teams to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriate hand offs are adhered to, and the appropriate approvals and escalations are achieved. Coordinates with Associate Vice President, Special Investigations Unit, Regulatory Operations (AVP- SIU) within to oversee the special investigations unit development of multiple state and corporate antifraud plans and annual audit plans development policy and procedure maintenance and departmental compliance and implementation. Responsibilities may include responding to external audits, coordination of state readiness reviews, policy and procedures development, prepayment review oversight, regulatory reporting oversight, maintaining a schedule of active corrective action plans and follow-up activities. Additional support may include data mining and data analysis rules development, developing audit tools based on regulatory and contractual requirements, summarizing and approving investigations, resolving escalated disputes from providers, members, or related entities, documenting and/or conducting investigations of potential FWA or over payment allegations

**Essential Duties & Responsibilities**

• Creates and manages effective monitoring metrics to continually evaluate vendor contract requirements are met including quality, cost control, timeliness and business relations

• Assures an adequate quality assurance program and process are in place and strictly adhered to for all tasks

• Ensures that all turn-around-times and quality measurements are met

• Identifies improvement opportunities in protocols, and creates projects to address opportunity from root cause analysis through implementation

• Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to avoid duplication of efforts, assuring case statuses and disputes are appropriately resolved, assures timeliness of resolution, and assures referral compliance adherence

• Performs reviews of case files for sufficiency of content and documentation, approves and signs-off where appropriate

• Implements the most effective and efficient method of investigation for each FWA case and administers outcomes with vendor

• Tracks on budgeted recoveries, and initiates appropriate action plans to assure program stays on track

• Provides guidance to operational managers on the implementation and completion of resulting action plans

• Directs training for SIU unit personnel on internal and external protocols and systems and investigative techniques

• Oversees data mining and data analysis to identify outliers/potential fraud, waste, abuse and overpayments within overall payment integrity framework

• Strategizes with cross functional teams on payment integrity program advancements and best practice development

• Responsible to engage staff and drive high level of change management and business process transformation

• Represents the payment integrity area at key stakeholder internal and external meetings

• Capitalizes on opportunities to create pre-payment edits for recurring overpayment instances with cross functional teams, and drives cost avoidance measures

• Develops and maintains payment integrity policy and procedures, and ensures that all activities conform to the policy and procedures

• Evaluates the work of personnel and completes all required performance review documentation as applicable

• Performs special projects as requested by Leadership

• Attends professional conferences as assigned to ensure ongoing knowledge of regulatory guidance

• Maintains professional and technical knowledge through appropriate activities and ongoing learning

• Other duties as identified and assigned.

**Job Qualifications**

**Required Education**

• Bachelor's degree in a related field.

**Required Experience**

• Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law Enforcement or Risk Management

• Minimum 8-10 years leadership/supervisory experience required

• Progressive management experience to manage complex work systems and workflows required

• Knowledge of pre-edit and pre and post payment audit protocol, and payment integrity program protocols

• Excellent oral and written communication skills

• Strong organizational and leadership skills

• Strong independent decision making and critical thinking skills

• Strong negotiation, and conflict management skills

• Ability to succeed in a fast paced environment with evolving workflow and changing priorities

• Proficiency in Microsoft Access, Word and Excel

• Knowledge and understanding of claims processing systems and medical claims

• Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations

**Preferred Education**

• Master's degree

**Preferred Experience**

• Formalized training/experience in Health Care Insurance Fraud

• Experience with Power BI, SAS, SQL other reporting software

• ICD-9, ICD-10 CPT-4, HCPCS coding

**Preferred License, Certification, Association**

Professional certifications/accreditations, such as CFE, AHFI, HCAFA

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: $97,299 - $189,732 / ANNUAL

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

**Job Summary**

Acts as liaison between Special Investigations Unit (SIU) operations and health plans and internal functional teams to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriate hand offs are adhered to, and the appropriate approvals and escalations are achieved. Coordinates with Associate Vice President, Special Investigations Unit, Regulatory Operations (AVP- SIU) within to oversee the special investigations unit development of multiple state and corporate antifraud plans and annual audit plans development policy and procedure maintenance and departmental compliance and implementation. Responsibilities may include responding to external audits, coordination of state readiness reviews, policy and procedures development, prepayment review oversight, regulatory reporting oversight, maintaining a schedule of active corrective action plans and follow-up activities. Additional support may include data mining and data analysis rules development, developing audit tools based on regulatory and contractual requirements, summarizing and approving investigations, resolving escalated disputes from providers, members, or related entities, documenting and/or conducting investigations of potential FWA or over payment allegations

**Essential Duties & Responsibilities**

• Creates and manages effective monitoring metrics to continually evaluate vendor contract requirements are met including quality, cost control, timeliness and business relations

• Assures an adequate quality assurance program and process are in place and strictly adhered to for all tasks

• Ensures that all turn-around-times and quality measurements are met

• Identifies improvement opportunities in protocols, and creates projects to address opportunity from root cause analysis through implementation

• Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to avoid duplication of efforts, assuring case statuses and disputes are appropriately resolved, assures timeliness of resolution, and assures referral compliance adherence

• Performs reviews of case files for sufficiency of content and documentation, approves and signs-off where appropriate

• Implements the most effective and efficient method of investigation for each FWA case and administers outcomes with vendor

• Tracks on budgeted recoveries, and initiates appropriate action plans to assure program stays on track

• Provides guidance to operational managers on the implementation and completion of resulting action plans

• Directs training for SIU unit personnel on internal and external protocols and systems and investigative techniques

• Oversees data mining and data analysis to identify outliers/potential fraud, waste, abuse and overpayments within overall payment integrity framework

• Strategizes with cross functional teams on payment integrity program advancements and best practice development

• Responsible to engage staff and drive high level of change management and business process transformation

• Represents the payment integrity area at key stakeholder internal and external meetings

• Capitalizes on opportunities to create pre-payment edits for recurring overpayment instances with cross functional teams, and drives cost avoidance measures

• Develops and maintains payment integrity policy and procedures, and ensures that all activities conform to the policy and procedures

• Evaluates the work of personnel and completes all required performance review documentation as applicable

• Performs special projects as requested by Leadership

• Attends professional conferences as assigned to ensure ongoing knowledge of regulatory guidance

• Maintains professional and technical knowledge through appropriate activities and ongoing learning

• Other duties as identified and assigned.

**Job Qualifications**

**Required Education**

• Bachelor's degree in a related field.

**Required Experience**

• Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law Enforcement or Risk Management

• Minimum 8-10 years leadership/supervisory experience required

• Progressive management experience to manage complex work systems and workflows required

• Knowledge of pre-edit and pre and post payment audit protocol, and payment integrity program protocols

• Excellent oral and written communication skills

• Strong organizational and leadership skills

• Strong independent decision making and critical thinking skills

• Strong negotiation, and conflict management skills

• Ability to succeed in a fast paced environment with evolving workflow and changing priorities

• Proficiency in Microsoft Access, Word and Excel

• Knowledge and understanding of claims processing systems and medical claims

• Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations

**Preferred Education**

• Master's degree

**Preferred Experience**

• Formalized training/experience in Health Care Insurance Fraud

• Experience with Power BI, SAS, SQL other reporting software

• ICD-9, ICD-10 CPT-4, HCPCS coding

**Preferred License, Certification, Association**

Professional certifications/accreditations, such as CFE, AHFI, HCAFA

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: $97,299 - $189,732 / ANNUAL

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

**Job Summary**

Acts as liaison between Special Investigations Unit (SIU) operations and health plans and internal functional teams to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriate hand offs are adhered to, and the appropriate approvals and escalations are achieved. Coordinates with Associate Vice President, Special Investigations Unit, Regulatory Operations (AVP- SIU) within to oversee the special investigations unit development of multiple state and corporate antifraud plans and annual audit plans development policy and procedure maintenance and departmental compliance and implementation. Responsibilities may include responding to external audits, coordination of state readiness reviews, policy and procedures development, prepayment review oversight, regulatory reporting oversight, maintaining a schedule of active corrective action plans and follow-up activities. Additional support may include data mining and data analysis rules development, developing audit tools based on regulatory and contractual requirements, summarizing and approving investigations, resolving escalated disputes from providers, members, or related entities, documenting and/or conducting investigations of potential FWA or over payment allegations

**Essential Duties & Responsibilities**

• Creates and manages effective monitoring metrics to continually evaluate vendor contract requirements are met including quality, cost control, timeliness and business relations

• Assures an adequate quality assurance program and process are in place and strictly adhered to for all tasks

• Ensures that all turn-around-times and quality measurements are met

• Identifies improvement opportunities in protocols, and creates projects to address opportunity from root cause analysis through implementation

• Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to avoid duplication of efforts, assuring case statuses and disputes are appropriately resolved, assures timeliness of resolution, and assures referral compliance adherence

• Performs reviews of case files for sufficiency of content and documentation, approves and signs-off where appropriate

• Implements the most effective and efficient method of investigation for each FWA case and administers outcomes with vendor

• Tracks on budgeted recoveries, and initiates appropriate action plans to assure program stays on track

• Provides guidance to operational managers on the implementation and completion of resulting action plans

• Directs training for SIU unit personnel on internal and external protocols and systems and investigative techniques

• Oversees data mining and data analysis to identify outliers/potential fraud, waste, abuse and overpayments within overall payment integrity framework

• Strategizes with cross functional teams on payment integrity program advancements and best practice development

• Responsible to engage staff and drive high level of change management and business process transformation

• Represents the payment integrity area at key stakeholder internal and external meetings

• Capitalizes on opportunities to create pre-payment edits for recurring overpayment instances with cross functional teams, and drives cost avoidance measures

• Develops and maintains payment integrity policy and procedures, and ensures that all activities conform to the policy and procedures

• Evaluates the work of personnel and completes all required performance review documentation as applicable

• Performs special projects as requested by Leadership

• Attends professional conferences as assigned to ensure ongoing knowledge of regulatory guidance

• Maintains professional and technical knowledge through appropriate activities and ongoing learning

• Other duties as identified and assigned.

**Job Qualifications**

**Required Education**

• Bachelor's degree in a related field.

**Required Experience**

• Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law Enforcement or Risk Management

• Minimum 8-10 years leadership/supervisory experience required

• Progressive management experience to manage complex work systems and workflows required

• Knowledge of pre-edit and pre and post payment audit protocol, and payment integrity program protocols

• Excellent oral and written communication skills

• Strong organizational and leadership skills

• Strong independent decision making and critical thinking skills

• Strong negotiation, and conflict management skills

• Ability to succeed in a fast paced environment with evolving workflow and changing priorities

• Proficiency in Microsoft Access, Word and Excel

• Knowledge and understanding of claims processing systems and medical claims

• Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations

**Preferred Education**

• Master's degree

**Preferred Experience**

• Formalized training/experience in Health Care Insurance Fraud

• Experience with Power BI, SAS, SQL other reporting software

• ICD-9, ICD-10 CPT-4, HCPCS coding

**Preferred License, Certification, Association**

Professional certifications/accreditations, such as CFE, AHFI, HCAFA

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: $97,299 - $189,732 / ANNUAL

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

**Job Summary**

Acts as liaison between Special Investigations Unit (SIU) operations and health plans and internal functional teams to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriate hand offs are adhered to, and the appropriate approvals and escalations are achieved. Coordinates with Associate Vice President, Special Investigations Unit, Regulatory Operations (AVP- SIU) within to oversee the special investigations unit development of multiple state and corporate antifraud plans and annual audit plans development policy and procedure maintenance and departmental compliance and implementation. Responsibilities may include responding to external audits, coordination of state readiness reviews, policy and procedures development, prepayment review oversight, regulatory reporting oversight, maintaining a schedule of active corrective action plans and follow-up activities. Additional support may include data mining and data analysis rules development, developing audit tools based on regulatory and contractual requirements, summarizing and approving investigations, resolving escalated disputes from providers, members, or related entities, documenting and/or conducting investigations of potential FWA or over payment allegations

**Essential Duties & Responsibilities**

• Creates and manages effective monitoring metrics to continually evaluate vendor contract requirements are met including quality, cost control, timeliness and business relations

• Assures an adequate quality assurance program and process are in place and strictly adhered to for all tasks

• Ensures that all turn-around-times and quality measurements are met

• Identifies improvement opportunities in protocols, and creates projects to address opportunity from root cause analysis through implementation

• Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to avoid duplication of efforts, assuring case statuses and disputes are appropriately resolved, assures timeliness of resolution, and assures referral compliance adherence

• Performs reviews of case files for sufficiency of content and documentation, approves and signs-off where appropriate

• Implements the most effective and efficient method of investigation for each FWA case and administers outcomes with vendor

• Tracks on budgeted recoveries, and initiates appropriate action plans to assure program stays on track

• Provides guidance to operational managers on the implementation and completion of resulting action plans

• Directs training for SIU unit personnel on internal and external protocols and systems and investigative techniques

• Oversees data mining and data analysis to identify outliers/potential fraud, waste, abuse and overpayments within overall payment integrity framework

• Strategizes with cross functional teams on payment integrity program advancements and best practice development

• Responsible to engage staff and drive high level of change management and business process transformation

• Represents the payment integrity area at key stakeholder internal and external meetings

• Capitalizes on opportunities to create pre-payment edits for recurring overpayment instances with cross functional teams, and drives cost avoidance measures

• Develops and maintains payment integrity policy and procedures, and ensures that all activities conform to the policy and procedures

• Evaluates the work of personnel and completes all required performance review documentation as applicable

• Performs special projects as requested by Leadership

• Attends professional conferences as assigned to ensure ongoing knowledge of regulatory guidance

• Maintains professional and technical knowledge through appropriate activities and ongoing learning

• Other duties as identified and assigned.

**Job Qualifications**

**Required Education**

• Bachelor's degree in a related field.

**Required Experience**

• Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law Enforcement or Risk Management

• Minimum 8-10 years leadership/supervisory experience required

• Progressive management experience to manage complex work systems and workflows required

• Knowledge of pre-edit and pre and post payment audit protocol, and payment integrity program protocols

• Excellent oral and written communication skills

• Strong organizational and leadership skills

• Strong independent decision making and critical thinking skills

• Strong negotiation, and conflict management skills

• Ability to succeed in a fast paced environment with evolving workflow and changing priorities

• Proficiency in Microsoft Access, Word and Excel

• Knowledge and understanding of claims processing systems and medical claims

• Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations

**Preferred Education**

• Master's degree

**Preferred Experience**

• Formalized training/experience in Health Care Insurance Fraud

• Experience with Power BI, SAS, SQL other reporting software

• ICD-9, ICD-10 CPT-4, HCPCS coding

**Preferred License, Certification, Association**

Professional certifications/accreditations, such as CFE, AHFI, HCAFA

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: $97,299 - $189,732 / ANNUAL

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

**Job Description**

**Work Arrangement:**

This role is based remotely, but if you live within a 50-mile radius of Atlanta, Austin, Detroit, Warren or Mountain View, you are expected to report to that location three times a week, at minimum.

**The Role:**

The Employee Relations Investigator will perform investigations of misconduct, and/or violations of policy. The Investigator will work closely with the HR Policy and Compliance & Special Investigations leadership in investigative efforts of suspected violations including, but not limited to, discrimination, harassment, retaliation, bullying, and violations of our Winning with Integrity policy.

**Subject Matter Requirements:**

+ Develop investigative plans; execute and document work in accordance with professional standards

+ Communicate investigation results clearly and timely to all constituencies.

+ Work cross functionally with HR, Audit, Security, Operations, and other constituencies

+ Collaborate with Policy team ongoing on items such as determining necessary proactive training efforts and equity in employment action

**Department Overview:**

As a member of the HR Policy and Investigations team, you will strive to be a role model for the Company by supporting the delivery of high-performance services with high integrity. The HR Policy and Investigations teams’ objectives are to deliver timely, best-in-class business advisory and services in close collaboration with business partners to accomplish their objectives while simultaneously protecting GM’s high standards of HR, legal, ethical, and financial integrity. Each member of this team, including Managers, are expected to adhere to these standards:

· Workplace and Product Safety

· Compliance & Ethics

· Strategic Partnering

· Responsive & Accountable

· Real-time Transparency and Communication

· Superior Work Product Quality

· Strong Work Ethic

· Controlling Costs

· Company and Industry Knowledge

· Teamwork

**Additional Job Description**

**Qualifications:**

+ At least 5 years of professional experience in Human Resources, or Corporate Global Investigations

+ Perform investigations of alleged misconduct at the direction of Leadership

+ Ability to identify and develop sources of information relative to the subject of the investigation

+ Conduct effective informational and interrogatory interviews

+ Evaluate systems of internal control and related procedures

+ Recommend changes in investigative process to improve efficiency/effectiveness while maintaining the highest quality standards

+ Maintain open, honest, and timely communication with personnel involved in investigations/projects

+ Ensure confidentiality of sensitive information is maintained

+ Managerial courage demonstrated through effective, direct, and respectful communication

+ Ability to collaborate, build relationships, gain credibility, and partner effectively with others up and down a matrixed organization

+ Ability to investigate objectively

+ Aptitude for critical thinking and succinctly presenting the best course of action

+ Exceptional organizational, analytical, leadership and interpersonal skills

+ Knowledge and understanding of automotive industry environment and business needs is a plus

**Compensation:**

+ The expected base compensation for this role is $85,100 – $135,900 USD Annually.

+ Actual base compensation within the identified range will vary based on factors relevant to the position.

+ Bonus Potential: An incentive pay program offers payouts based on company performance, job level, and individual performance.

GM DOES NOT PROVIDE IMMIGRATION-RELATED SPONSORSHIP FOR THIS ROLE. DO NOT APPLY FOR THIS ROLE IF YOU WILL NEED GM IMMIGRATION SPONSORSHIP (e.g., H-1B, TN, STEM OPT, etc.) NOW OR IN THE FUTURE.

\#LI-NR1

**About GM**

Our vision is a world with Zero Crashes, Zero Emissions and Zero Congestion and we embrace the responsibility to lead the change that will make our world better, safer and more equitable for all.

**Why Join Us**

We aspire to be the most inclusive company in the world. We believe we all must make a choice every day – individually and collectively – to drive meaningful change through our words, our deeds and our culture. Our Work Appropriately philosophy supports our foundation of inclusion and provides employees the flexibility to work where they can have the greatest impact on achieving our goals, dependent on role needs. Every day, we want every employee, no matter their background, ethnicity, preferences, or location, to feel they belong to one General Motors team.

**Benefits Overview**

The goal of the General Motors total rewards program is to support the health and well-being of you and your family. Our comprehensive compensation plan incudes, the following benefits, in addition to many others:

• Paid time off including vacation days, holidays, and parental leave for mothers, fathers and adoptive parents;

• Healthcare (including a triple tax advantaged health savings account and wellness incentive), dental, vision and life insurance plans to cover you and your family;

• Company and matching contributions to 401K savings plan to help you save for retirement;

• Global recognition program for peers and leaders to recognize and be recognized for results and behaviors that reflect our company values;

• Tuition assistance and student loan refinancing;

• Discount on GM vehicles for you, your family and friends.

**Diversity Information**

General Motors is committed to being a workplace that is not only free of discrimination, but one that genuinely fosters inclusion and belonging. We strongly believe that workforce diversity creates an environment in which our employees can thrive and develop better products for our customers. We understand and embrace the variety through which people gain experiences whether through professional, personal, educational, or volunteer opportunities. GM is proud to be an equal opportunity employer.

We encourage interested candidates to review the key responsibilities and qualifications and apply for any positions that match your skills and capabilities.

**Equal Employment Opportunity Statements**

GM is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. GM is committed to providing a work environment free from unlawful discrimination and advancing equal employment opportunities for all qualified individuals. As part of this commitment, all practices and decisions relating to terms and conditions of employment, including, but not limited to, recruiting, hiring, training, promotion, discipline, compensation, benefits, and termination of employment are made without regard to an individual's protected characteristics. For purposes of this policy, “protected characteristics" include an individual's actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, weight, height, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state or local laws and ordinances. If you need a reasonable accommodation to assist with your job search or application for employment, email us at Careers.Accommodations@GM.com or call us at 800-865-7580. In your email, please include a description of the specific accommodation you are requesting as well as the job title and requisition number of the position for which you are applying.​

We are leading the change to make our world better, safer and more equitable for all through our actions and how we behave. Learn more about:

**Our Company (https://search-careers.gm.com/en/working-at-gm/)**

**Our Culture**

**How we hire​​​​​​​ (https://search-careers.gm.com/en/how-we-hire/)**

Our diverse team of employees bring their collective passion for engineering, technology and design to deliver on our vision of a world with Zero Crashes, Zero Emissions and Zero Congestion. We are looking for adventure-seekers and imaginative thought leaders to help us transform mobility.

**Explore our global location** **s**

The policy of General Motors is to extend opportunities to qualified applicants and employees on an equal basis regardless of an individual's age, race, color, sex, religion, national origin, disability, sexual orientation, gender identity/expression or veteran status. Additionally, General Motors is committed to being an Equal Employment Opportunity Employer and offers opportunities to all job seekers including individuals with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, email us at Careers.Accommodations@GM.com .In your email, please include a description of the specific accommodation you are requesting as well as the job title and requisition number of the position for which you are applying.

Senior Investigator

Requisition ID: 137763

Location:

Phoenix, AZ, US, 85004-2121

Category: Legal

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Why You Should Apply For This Job:

**Why You Should Apply for This Job**

At Freeport-McMoRan, we are committed to providing employment that recognizes excellence and encourages safe production, with a culture supported by our core values. Here, you’ll find a collaborative environment where safety is a top priority. **_Apply Today! _**

**Where You Will Work **

Our global headquarters is in Phoenix, Arizona. Several hundred employees support our operations in finance, human resources, health and safety, information technology, planning, and more. Our flexible work program allows employees to work virtually as well as come together in person when needed at our Collaboration Hub in Phoenix and/or one of our site locations. Employees can work remotely from most states in the U.S., with the exception of California, Connecticut, Illinois, Kansas, Kentucky, Massachusetts, Michigan, New Hampshire, New York, North Carolina, Oklahoma and South Carolina. Additional states may be excluded from remote work based on business factors. Should the position shift to in-person (office/site) work in the future, the company will offer relocation benefits at that time, so long as the position meets the established eligibility for these benefits.

**Description**

Conduct assigned investigation including planning, conducting investigations, litigation prep and reporting and closure for cases for North America sites. Conduct review with legal to ensure compliance with local, national laws and regulations.

+ Conduct regulatory (MSHA, EEOC, etc.) and non-regulatory (PBC, Guiding principles, etc.) investigations from intake through resolution, some of which are complex and difficult

+ Develop investigation plans; assign administrative investigation tasks to appropriate teams or Local HR, review investigation outcome, collect any actions taken, and monitor investigation compliance

+ Conduct investigation consistent with standardized investigation process, generate and issue reports on findings; provide guidance to field HR on standardized process

+ Support the investigation process by aligning with business needs, designing investigation outcome communications for involved parties, and assigning appropriate resources to communicate outcomes

+ Resolve and respond to escalations from the HR Service Center by collaborating with peers to conduct research, investigate inquiries and provide resolution

+ Research and propose Investigation leading practices and proposed process improvements to Investigation management

+ Maintain and update Investigation policies and procedures based on leading practice findings, local and national laws, service level metrics, manager delegations and inquiry escalations

+ Collaborate with peers, HR Business Partners, HR Centers of Expertise (COEs) and the business customers, assist in maintaining relationships to improve and implement Investigation solutions and service delivery

+ Perform other duties as requested

**Qualifications**

**Minimum Qualifications**

+ Bachelor’s degree in Business, Human Resources, or related discipline **and** five (5) years experience conducting employment or compliance related investigations; **OR**

+ High School diploma or GED **and** nine (9) years experience conducting employment or compliance related investigations

+ Knowledge of policies, procedures and best practices particularly in Investigation

+ Knowledge of local, federal and labor laws

+ Business acumen (business management, financials, and information technology)

+ Skill in developing and maintaining influential relationships with customers, supervisors and peers

+ Skill in ethical decision making and applying the principles of business conduct

+ Skill in collaborative work efforts with peers, Local HR Managers and Generalists, and all levels of management

+ Skill in effective communication, both verbal and written

+ Skill in Microsoft programs (Excel, Word, PowerPoint)

+ Ability to work effectively in an environment subject to changing priorities and short deadlines

**Preferred Qualifications**

+ Experience working in compliance or investigations

+ Experience in mining, natural resources or similar industry

+ Frequent travels

**Criteria/Conditions**

+ Ability to understand and apply verbal and written work and safety-related instructions and procedures given in English

+ Ability to communicate in English with respect to job assignments, job procedures, and applicable safety standards

+ Must be able to work in a potentially stressful environment

+ Physical demands are consistent with standard office work, including ability to sit for several hours at a time

+ Frequent domestic travels

+ Personal protective equipment is required when performing work in a mine, outdoor, manufacturing or plant environment, including hard hat, hearing protection, safety glasses, safety footwear, and as needed, respirator, rubber steel-toe boots, protective clothing, gloves and any other protective equipment as required

+ Freeport-McMoRan promotes a drug/alcohol free work environment through the use of mandatory pre-employment drug testing and on-going random drug testing

**What We Offer You**

The estimated annual pay range for this role is currently **$72,000-$98,000.** This range reflects base salary only and does not include bonus payments, benefits or retirement contributions. Actual base pay is determined by experience, qualifications, skills and other job-related factors. This role is eligible for additional discretionary and incentive payment considerations based on company and individual performance. More details will be shared during the hiring process. **Click here (https://performancemanager4.successfactors.com/doc/custom/freeportmc/Corp\_Total\_Rewards\_Estimate\_3\_4\_24v2.pdf)** to view a sample of Total Rewards Estimate for this role.

+ Affordable medical, dental and vision benefits

+ Company-paid life and disability insurance

+ 401(k) plan with employer contribution/match

+ Paid time off, paid sick time, holiday pay, parental leave

+ Tuition Assistance

+ Employee Assistance Program

+ Discounted insurance plans for auto, home and pet

+ Internal progression opportunities

+ Learn more (https://jobs.fcx.com/content/Benefits/?locale=en\_US) about our competitive and comprehensive benefits package!

**What We Require**

+ Ability to travel as needed, may include international travel and travel to remote locations.

+ Freeport-McMoRan promotes a drug/alcohol-free work environment using mandatory pre-employment drug testing as allowed by applicable laws.

**Equal Opportunity Employer**

_Please be advised Freeport-McMoRan will never request payment for job-related expenses from applicants. If you receive any suspicious emails, please disregard them, and report the incident to HRSC@fmi.com._