Description Office of Compliance Services Support a high-impact compliance investigation function focused on integrity, risk mitigation, and regulatory accountability. The Senior Compliance Investigator leads and conducts compliance investigations involving potential regulatory concerns, including fraud, waste, abuse, and violations of federal and state regulations and UC and organizational policies. This role involves gathering and analyzing evidence, conducting interviews, preparing investigative reports, monitoring corrective actions, and partnering with stakeholders to strengthen compliance across the enterprise.
In this role, you will: Lead and conduct complex compliance investigations of reported compliance concerns, involving fraud, waste, abuse, and policy violations. Gather, analyze, and evaluate evidence, including documents, data, and records, to support investigative findings. Conduct Interviews with employees, patients, and external parties, exercising professionalism and discretion in sensitive situations.
Prepare clear, detailed investigative reports that outline findings, conclusions, and recommended corrective actions. Partner with Legal Affairs, Risk Management, Human Resources, and other stakeholders on investigation outcomes. Monitor and evaluate corrective actions to ensure effective resolution.
Stay current with federal and state healthcare regulations, enforcement trends, and compliance best practices. Support the development and delivery of compliance training and education informed by investigation findings. Identify trends and emerging risks based on investigation findings and contribute to broader compliance risk assessments, as well as the enhancement of departmental investigative processes and tools.
Maintain thorough, accurate, and confidential investigation records in compliance tracking systems and databases. Salary Range: The full salary range for this position is $108,900 to $241,500, with an anticipated hiring range between $115,000 to $165,000, depending on qualifications and experience. Qualifications Required Bachelor’s degree from an accredited academic institution or equivalent experience.
Minimum of seven years of experience conducting investigations, preferably within a healthcare setting or involving healthcare compliance matters. Strong knowledge of federal and state healthcare regulations, including Stark Law, Anti-Kickback Statute, and related laws. Demonstrated experience leading investigations, interviewing witnesses, analyzing evidence, preparing investigation reports, and managing corrective action follow-up.
Experience developing or contributing to educational content or compliance training materials. Strong analytical, problem-solving, critical-thinking, organizational, and communication skills. Ability to manage multiple investigations, competing priorities, and sensitive matters with sound judgment and professionalism.
Ability to work effectively with senior management, staff, and cross-functional stakeholders in a complex environment. High level of integrity, ethical conduct, and commitment to maintaining confidentiality. Proficiency with Microsoft Office applications.
Experience working with compliance tracking systems or databases and maintaining detailed documentation. Preferred Advanced degree, such as a JD or Master’s degree, is preferred. Prior experience as an investigator with a local, state, or federal law enforcement or regulatory agency, such as HHS OIG or FBI, is highly desirable.