Temporary Special Investigations Unit (SIU) Specialist

Job Type

Temporary Onsite

Location

Rancho Cucamonga, California

Job Summary

We are seeking a Temporary Special Investigations Unit (SIU) Specialist to support fraud, waste, and abuse (FWA) investigations within a healthcare environment. This role is responsible for receiving, reviewing, and coordinating FWA referrals, performing initial case assessments, documenting findings, analyzing referral data, and supporting proactive fraud detection efforts through case management and analytics tools.

This is an excellent opportunity for professionals with experience in healthcare compliance, managed care, fraud investigations, or healthcare billing and coding.

Key Responsibilities
Receive, review, and coordinate Fraud, Waste, and Abuse (FWA) referrals.
Perform initial case assessments and prioritize referrals based on risk and potential impact.
Document and maintain accurate case records in the case management system.
Organize, analyze, and report referral data to support investigations.
Utilize healthcare fraud analytics and case management tools to identify potential fraud trends.
Support proactive fraud detection and compliance initiatives.
Manage multiple cases while meeting deadlines.
Collaborate with internal departments and external partners during investigations.
Maintain confidentiality and adhere to ethical and compliance standards.
Qualifications
Required
High School Diploma or GED.
Minimum 3 years of experience in a healthcare environment.
Strong analytical, organizational, and communication skills.
Intermediate to advanced proficiency in Microsoft Excel.
Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint).
Ability to work independently and as part of a team.
Strong attention to detail and commitment to integrity.
Preferred
Experience in managed care.
Experience in fraud investigations, compliance, healthcare billing, or coding.
Associate's or Bachelor's degree from an accredited institution.
AHFI (Accredited Healthcare Fraud Investigator), CPC (Certified Professional Coder), or similar healthcare fraud/coding certification.
Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms.
Skills Required
Healthcare fraud, waste, and abuse (FWA) knowledge.
Case management and investigation support.
Data analysis and reporting.
Time management and multitasking.
Professional written and verbal communication.
Ethical decision-making and confidentiality.