Detectives and Criminal Investigators

**Why USAA?**

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

**The Opportunity**

USAA's Risk and Compliance team is seeking a highly skilled and experienced Risk and Compliance Advisor Senior to improve our organization's security measures. This role is ideal for a meticulous professional with expertise in areas such as Physical Security, Corporate Investigations, or Identity and Access Management (IAM). The successful candidate will have a comprehensive understanding of authentication methods, user lifecycle management, access control policies, and compliance regulations. This position offers a significant opportunity to strengthen USAA's security and compliance posture through proactive risk management and standard processes.

We offer a flexible work environment that requires an individual to be **in the office 4 days per week.** This position can be based in one of the following locations: San Antonio, TX, Plano, TX, Phoenix, AZ, Colorado Springs, CO, Charlotte, NC, Chesapeake, VA or Tampa, FL.

Relocation assistance is **not** available for this position.

**What you'll do:**

+ Partners and provides guidance to key customers in the business to identify, assess, aggregate and document risks and compliance controls, including risks associated with new or modified products, services, distribution channels, regulations, and third-party operations.

+ Communicates' results of risk and compliance work to governance committees, business process owners and various levels of leadership.

+ Implements new risk policies, practices, appetites, and solutions to ensure multidisciplinary understanding and management of risks according to industry standard process.

+ Implements assigned risk and compliance activities assigned in accordance with enterprise policies and procedures.

+ Maintains and expands knowledge of the competitive/regulatory landscape and the company's key challenges.

+ Coordinates and responds to regulatory requirements and requests and ensures the execution of examinations.

+ Supplies to strategies, tools, and methodologies to measure, monitor, and report risks.

+ Applies authority risk and compliance knowledge to use or produce analytical material for discussions with cross functional teams to understand business objectives and influence solution strategies.

+ Serves as contributor in cross-functional teams to identify, assess, aggregate, and mitigate current and emerging risk events.

+ Formulates stress test plans for a line of business or the enterprise including the evaluation of results and framing of contingency plans in partnership with key business partners.

**What you have:**

+ Bachelor’s degree or 4 additional years of related experience beyond the minimum required may be substituted in lieu of a degree.

+ 6 years experience in risk, compliance, legal or audit within the financial services or insurance industry or technical fields directly related to the role.

+ Risk and compliance management experience working in a large institution and/or highly matrixed environment.

+ In-depth knowledge of compliance laws, regulations, and regulatory expectations.

+ Ability to apply regulatory risk and compliance knowledge o to consult and provide insights and guidance to business partners and peers.

+ Experience in conflict resolution management and ability to challenge at all levels of management and influence business outcomes.

+ Ability to work with internal and external partners in a highly collaborative environment.

+ Critical thinking and knowledge of data analysis tools and techniques and decision-making abilities, to include ability to make data-driven decisions.

+ Proactively identifies potential concerns and resolves issues.

+ Proficiency with Microsoft Office products including Word, Excel, and PowerPoint.

**What sets you apart:**

+ Experience conducting monitoring, testing, and/or other types of assessments.

+ Experience in second or third line of defense function, business risks and controls.

+ Strong understanding of authentication methods, authorization protocols, access control policies, access compliance regulations, fraud prevention and/or detection, and physical security methodologies.

+ Risk and Compliance industry certifications or designations (CFE, CAFS, CISSP, CRISC, CIAM, or CIMP).

+ Ability to communicate across the 1st and 2nd Lines of Defense and build collaborative relationships.

+ Strong understanding of NIST 800-53, NIST 800-63, SOC2, GDPR, etc.

+ Extensive experience with accuracy and attention to detail and ability to present at all levels.

+ Ability to synthesize data to tell a story for senior leadership and present clearly articulated rationale that details required attributes compared to what was received for regulatory audiences.

+ US military experience through military service or a military spouse/domestic partner

**Compensation range:** The salary range for this position is: $114,080 - $218,030 **.**

**USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).**

**Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

**Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com.

_Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._

_USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran._

**If you are an existing USAA employee, please use the internal career site in OneSource to apply.**

**Please do not type your first and last name in all caps.**

**_Find your purpose. Join our mission._**

USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity.

USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself – you just need to share our passion for serving our more than 13 million members.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

California applicants, please review our HR CCPA - Notice at Collection (https://statmcstg.usaa.com/mcontent/static\_assets/Media/enterprise\_hr\_cpra\_notice\_at\_collection.pdf) here.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

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

**Job Description**

Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an effective risk management framework. Participates in projects and/or activities that ensure compliance with applicable federal, state, and local laws and regulations. Identifies gaps and inform solutions that minimize losses resulting from inadequate internal processes, systems or human errors. Identifies, responds and/or escalates risks as appropriate. Serves as a functional liaison between the Line of Business and the Lines of Defense.

External Fraud Investigators may concentrate on one specific or many different fraud typologies such as external fraud, elder and vulnerable adult financial exploitation, technology related fraud, organized fraud rings and anti-money laundering depending on business needs within Fraud Investigations.

External Fraud Investigators perform duties such as:

+ Investigating multiple fraud typologies in accordance with policies and procedures

+ Performing thorough account transaction analysis for the purpose of identifying suspicious or fraudulent activity, and filing Suspicious Activity Reports (SARs).

+ An investigator may review consumer and commercial DDAs, loans, lines of credit, debit and credit cards, technology products and investment products.

+ Maintain thorough and accurate case notes setting forth all required actions in chronological order through utilization of a case management system.

+ Conduct and documenting interviews with witnesses, victims and subjects as appropriate.

+ Report investigative findings to the appropriate designee within Fraud Investigations with recommendation for SAR or no SAR Determination.

+ Prepare complete and accurate SARs for filing.

+ Ability to correctly identify when matters are appropriate to escalate to management and/or to law enforcement.

+ Ensure case accurate case completion for all case resolutions prior to submission to appropriate designee within Fraud Investigations for case closure approval.

+ Participation and compliance with internal continuing education and training. Training topics may include: Compliance with the U.S. Bank Code of Ethics and all Anti-Money Laundering, Bank Secrecy Act, information security and suspicious activity reporting requirements, policies and procedures. Participation in any required corporate and business line training in these areas.

+ Understanding and adherences to internal suspicious activity referral requirements and processes as required for this position.

**Basic Qualifications**

- Bachelor's degree, or equivalent work experience

- Typically more than two years of experience in an applicable risk management environment

**Preferred Skills/Experience**

- Certified Fraud Examiner (CFE) or other professional fraud certification

- Experience interviewing suspects and/or victims

- SAR writing and quality assurance experience

- Prior investigation experience

- Prior law enforcement experience

- Prior financial/banking sector experience

- Prior accounting/auditing experience

- Computer/digital forensic skills

- Strong analytical skills

- Strong proficiency in MS Excel and MS Word

- Excellent written and verbal communication skills

- Ability to maintain high levels of confidentiality and data security standards.

- Ability to handle multiple complex assignments concurrently

- Strong time management skills and high degree of initiative

- Demonstrated positive attitude with results orientation

- Proven track record of meeting tight deadlines

- Experience/comfort in working through change

_**The role offers a hybrid/flexible schedule, which means there's an in-office expectation of 3 or more days per week and the flexibility to work outside the office location for the other days.**_

**NOTE** **:** **this External Fraud Investigator position will be required to be onsite 5-days per week during training (the first 3-6 months in role) and until production goals are met.**

****We are hiring in the following locations:**

+ Brookfield, WI

+ Tempe, AZ

+ Charlotte, NC

+ Columbus, OH

+ Cincinnati, OH

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

**Benefits:**

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

+ Healthcare (medical, dental, vision)

+ Basic term and optional term life insurance

+ Short-term and long-term disability

+ Pregnancy disability and parental leave

+ 401(k) and employer-funded retirement plan

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

+ Up to 11 paid holiday opportunities

+ Adoption assistance

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

U.S. Bank is an equal opportunity employer. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or veteran status, and other factors protected under applicable law.

**E-Verify**

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

The salary range reflects figures based on the primary location, which is listed first. The actual range for the role may differ based on the location of the role. In addition to salary, U.S. Bank offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase 401(k) contribution and pension (all benefits are subject to eligibility requirements). Pay Range: $66,640.00 - $78,400.00 - $86,240.00

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

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

**Posting may be closed earlier due to high volume of applicants.**

Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations, multi-line insurance claims, criminal and civil background checks, and other investigative tasks.

The majority of cases worked in this position require stationary and mobile surveillance.

PRINCIPAL RESPONSIBILITIES FOR SURVEILLANCE:

+ Thoroughly complete assigned cases.

+ Testify to the collected facts obtained in any hearing or court of law as needed.

+ Assist other investigators on challenging cases.

+ Make sound judgments both during the investigation and with future handling recommendations.

+ Turn in updates, evidence, and report in timely manner.

+ Upload surveillance video upon completion of investigation.

+ The nature of this job requires early hours, long days, and travel into surrounding areas.

WHO SHOULD APPLY:

We are looking for people who are enthusiastic about investigations, those who thrive in a diverse work environment, and individuals who have a commitment to the very highest standards of honesty, integrity and respect.

Candidates with a valid AZ private investigator license and least one year of private investigator experience are strongly encouraged to apply.

POSITION QUALIFICATIONS:

+ Candidates must be willing and able to obtain an Arizona Private Investigator license.

+ Self-motivated, determined, and intuitive.

+ Strong initiative and work ethic.

+ Ability to identify critical issues quickly and accurately

+ Demonstrated observational, organizational, and listening skills.

+ Excellent oral and written communication.

+ Ability to work independently, as well as in a team.

+ Flexible schedule working weekends, holidays, and possible evenings.

+ Candidate must own a reliable computer, preferably a laptop.

+ Access to high-speed internet and a scanner or fax machine.

+ Must have strong computer and internet skills.

+ Proficient with a digital camera.

+ Must own reliable transportation.

+ Possess a valid driving license.

+ Upon hire, candidate will be asked to submit a driving record provided by the state DMV or Secretary of State.

+ Applicants must pass an extensive background check.

+ Must be able to pass a drug test with negative results (except when undergoing documented medical treatment).

+ College Degree preferred.

TRAINING

The Robison Group provides remote and/or in-classroom training to ensure that individuals are set up for success before moving into their roles.

COMPENSATION & REIMBURSEMENTS:

+ Paid travel time and reimbursement for mileage, tolls, and other per diem items.

+ Hourly Rate is commensurate with education and experience.

OPPORTUNITIES FOR GROWTH WITHIN THE COMPANY INCLUDE:

SIU work, Field Supervisor, Field Operations Manager, Case Management, etc.

Department

Surveillance

Employment Type

Full time

Minimum Experience

Entry-level

**Date Posted:**

2025-05-07

**Country:**

United States of America

**Location:**

VA108: 1100 Wilson Blvd, Arlington 1100 Wilson Boulevard

, Arlington, VA, 22209 USA

**Position Role Type:**

Hybrid

**U.S. Citizen, U.S. Person, or Immigration Status Requirements:**

This job requires a U.S. Person. A U.S. Person is a lawful permanent resident as defined in 8 U.S.C. 1101(a)(20) or who is a protected individual as defined by 8 U.S.C. 1324b(a)(3). U.S. citizens, U.S. nationals, U.S. permanent residents, or individuals granted refugee or asylee status in the U.S. are considered U.S. persons.

For a complete definition of “U.S. Person” go here.
https://www.ecfr.gov/current/title-22/chapter-I/subchapter-M/part-120/subpart-C/section-120.62

**Security Clearance:**

None/Not Required

At Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter aggression. We bring the strength of more than 100 years of experience and renowned engineering expertise to meet the needs of today’s mission and stay ahead of tomorrow’s threat. Our team solves tough, meaningful problems that create a safer, more secure world.

We have an exciting opportunity for a Senior Counsel, supporting Global Trade Investigations & Disclosures who will provide legal advice and approvals, as well as manage internal investigations related to regulatory and policy violations specific to Global Trade (GT) compliance areas such as: International Traffic in Arms Regulations (ITAR) Export Administration Regulation (EAR), Arms Export Control Act (AECA), U.S Customs & Border Patrol regulations (USCBP), Office of Foreign Asset Control (OFAC) sanctions, and U.S. Antiboycott laws.

**What You Will Do**

+ Manage a dynamic caseload of Global Trade regulatory and policy violation investigations.

+ Research and advise on complex legal and compliance questions related to the ITAR, EAR, USCBP regulations, OFAC sanctions, and U.S. Antiboycott laws.

+ Review proposed transactions for compliance with U.S. and applicable non-U.S. sanctions.

+ Provide guidance on process, policy, regulations and/or other Global Trade requirements to Global Trade staff and/or other business stakeholders.

+ Manage development and closure of corrective actions and process improvement tasks.

+ Represent the company in communications with government regulatory and enforcement agencies.

+ Facilitate Global Trade compliance reviews across the company’s international subsidiaries and joint ventures.

+ Monitor and address proposed and implemented changes in law that will impact business operations and/or compliance programs.

+ Take leadership roles on corporate steering committees/task teams to engage in developing and/or guide policy & process changes across the corporation.

+ Coordinate with RTX Consent Agreement team, contribute to internal reporting on progress to requirements, assist in drafting semi-annual reports, and working with external auditors.

**Qualifications You Must Have**

+ Typically requires a minimum 12 years of relevant legal experience in Global Trade licensing requirements and processes

+ Juris Doctorate degree from an accredited U.S. law school

+ Member of a state bar in good standing

+ Experience with advising on Global Trade impacts to international and domestic contracts, purchase orders, and/or other transactional agreements

+ 5 years or more experience leading compliance investigations, maintaining legal privilege and briefing leadership and stakeholders to a resolution

**Qualifications We Prefer**

+ Extensive experience managing and submitting disclosures to U.S. regulators regarding Global Trade compliance violations

+ Extensive experience with export commodity classification requirements under the ITAR and EAR

+ Experience with U.S. Customs & Border Patrol regulations and requirements

+ Experience advising on compliance requirements specific to U.S. defense contracts

+ Excellent interpersonal, communication and writing skills

+ Strong project and time management experience

+ Ability to obtain a U.S. Security Clearance

**What We Offer**

Our values drive our actions, behaviors, and performance with a vision for a safer, more connected world. At RTX we value: Trust, Respect, Accountability, Collaboration, and Innovation.

Whether you’re just starting out on your career journey or are an experienced professional, we offer a robust total rewards package that goes above and beyond with compensation; healthcare, wellness, retirement, and work/life benefits; career development and recognition programs. Some of the superior benefits we offer include parental (including paternal) leave, flexible work schedules, achievement awards, educational assistance, and child/adult backup care.

**Learn More & Apply Now!**

Please consider the following role type definition as you apply for this role.

+ Hybrid: Employees who are working in Hybrid roles will work regularly both onsite and offsite. Ratio of time working onsite will be determined in partnership with your leader. Please see requisition details for approved work locations.

Raytheon Sites Virtual Tour | Raytheon (https://careers.rtx.com/global/en/raytheon-sites-virtual-tour) - With more than 50 Raytheon locations across the U.S., our team of difference-makers are building advanced technologies that power smarter, more connected defense solutions. Explore some of our key facilities to see how we’re delivering for all those who defend us.

The salary range for this role is 194,000 USD - 388,000 USD. The salary range provided is a good faith estimate representative of all experience levels.

RTX considers several factors when extending an offer, including but not limited to, the role, function and associated responsibilities, a candidate’s work experience, location, education/training, and key skills.

Hired applicants may be eligible for benefits, including but not limited to, medical, dental, vision, life insurance, short-term disability, long-term disability, 401(k) match, flexible spending accounts, flexible work schedules, employee assistance program, Employee Scholar Program, parental leave, paid time off, and holidays. Specific benefits are dependent upon the specific business unit as well as whether or not the position is covered by a collective-bargaining agreement.

Hired applicants may be eligible for annual short-term and/or long-term incentive compensation programs depending on the level of the position and whether or not it is covered by a collective-bargaining agreement. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance.

This role is a U.S.-based role. If the successful candidate resides in a U.S. territory, the appropriate pay structure and benefits will apply.

RTX anticipates the application window closing approximately 40 days from the date the notice was posted. However, factors such as candidate flow and business necessity may require RTX to shorten or extend the application window.

_RTX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status, or any other applicable state or federal protected class. RTX provides affirmative action in employment for qualified Individuals with a Disability and Protected Veterans in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans’ Readjustment Assistance Act._

**Privacy Policy and Terms:**

Click on this link (http://www.rtx.com/privacy/Job-Applicant-Privacy-Notice) to read the Policy and Terms

Raytheon Technologies is An Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status, age or any other federally protected class.

**JOB DESCRIPTION**

**Job Summary**

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical determinations as necessary, and applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

• Perform objective desk and onsite medical record audits to verify if services were supported by documentation, to determine if services were appropriately administered, and/or to validate coding/billing accuracy.

• Conduct interviews of providers and/or health plan members in order to determine whether fraud, waste, or abuse may have occurred.

• Coordinate with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations.

• Detect potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.

• Incorporate leadership and communication skills to work with physicians and other health professionals when investigating cases.

• Generate and provide accurate and timely written reports for internal and/external use detailing audit findings.

• Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.

• Identify opportunities for improvement through the audit process and provide recommendations for system enhancement in order to augment investigative outcomes and performance.

**JOB QUALIFICATIONS**

**REQUIRED EDUCATION** :

Graduate from an Accredited School of Nursing.

+ **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

+ Five years clinical nursing experience with broad clinical knowledge.

+ Five years experience conducting medical review and coding/billing audits involving professional and facility based services.

+ Knowledge and understanding of medical terminology along with demonstrated knowledge of CPT, ICD-9, HCPCS and DRG requirements.

+ Two years of managed care experience.

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

Active, unrestricted State Registered Nursing (RN) license in good standing.

**PREFERRED EDUCATION** :

Bachelor’s Degree in Nursing

**PREFERRED EXPERIENCE** :

+ Experience in government programs (i.e., Medicare, Medicaid, & SCHIP).

+ Experience in long-term care.

**STATE SPECIFIC REQUIREMENTS** :

OHIO:

+ Transitions of Care for New Members

+ Molina Healthcare of Ohio follows the transition of care requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from fee-for-service (FFS) or another MCO. The Transition of Care Coach will coordinate all services with new members to ensure a seamless transition and ensure continuity of care.

+ Provision of Member Information

+ Pre-Enrollment Planning

+ The Molina Transition of Care Coach coordinates with and utilizes data provided by ODM, another MCO, the OhioRISE Plan (when applicable) and or collected by Molina (e.g. through assessments, new member outreach in advance of the member’s enrollment effective date) to identify existing sources of care and to ensure each new member is able to continue to receive existing services without disruption.

+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE Plan in pre-enrollment planning

+ Continuation of Services for Members

+ Documentation of Transition of Services

+ Transitions of Care Between Health Care Settings

+ Transitions of Care Between Molina Healthcare of Ohio and the OhioRISE Plan

+ Care Coordination Assignment

+ Provision of Member Information

+ Continuation of Services for Members

+ Documentation of Transition of Services

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: $77,969 - $128,519 / ANNUAL

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

**JOB DESCRIPTION**

**Job Summary**

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical determinations as necessary, and applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

• Perform objective desk and onsite medical record audits to verify if services were supported by documentation, to determine if services were appropriately administered, and/or to validate coding/billing accuracy.

• Conduct interviews of providers and/or health plan members in order to determine whether fraud, waste, or abuse may have occurred.

• Coordinate with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations.

• Detect potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.

• Incorporate leadership and communication skills to work with physicians and other health professionals when investigating cases.

• Generate and provide accurate and timely written reports for internal and/external use detailing audit findings.

• Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.

• Identify opportunities for improvement through the audit process and provide recommendations for system enhancement in order to augment investigative outcomes and performance.

**JOB QUALIFICATIONS**

**REQUIRED EDUCATION** :

Graduate from an Accredited School of Nursing.

+ **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

+ Five years clinical nursing experience with broad clinical knowledge.

+ Five years experience conducting medical review and coding/billing audits involving professional and facility based services.

+ Knowledge and understanding of medical terminology along with demonstrated knowledge of CPT, ICD-9, HCPCS and DRG requirements.

+ Two years of managed care experience.

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

Active, unrestricted State Registered Nursing (RN) license in good standing.

**PREFERRED EDUCATION** :

Bachelor’s Degree in Nursing

**PREFERRED EXPERIENCE** :

+ Experience in government programs (i.e., Medicare, Medicaid, & SCHIP).

+ Experience in long-term care.

**STATE SPECIFIC REQUIREMENTS** :

OHIO:

+ Transitions of Care for New Members

+ Molina Healthcare of Ohio follows the transition of care requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from fee-for-service (FFS) or another MCO. The Transition of Care Coach will coordinate all services with new members to ensure a seamless transition and ensure continuity of care.

+ Provision of Member Information

+ Pre-Enrollment Planning

+ The Molina Transition of Care Coach coordinates with and utilizes data provided by ODM, another MCO, the OhioRISE Plan (when applicable) and or collected by Molina (e.g. through assessments, new member outreach in advance of the member’s enrollment effective date) to identify existing sources of care and to ensure each new member is able to continue to receive existing services without disruption.

+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE Plan in pre-enrollment planning

+ Continuation of Services for Members

+ Documentation of Transition of Services

+ Transitions of Care Between Health Care Settings

+ Transitions of Care Between Molina Healthcare of Ohio and the OhioRISE Plan

+ Care Coordination Assignment

+ Provision of Member Information

+ Continuation of Services for Members

+ Documentation of Transition of Services

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: $77,969 - $128,519 / ANNUAL

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

**JOB DESCRIPTION**

**Job Summary**

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical determinations as necessary, and applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

• Perform objective desk and onsite medical record audits to verify if services were supported by documentation, to determine if services were appropriately administered, and/or to validate coding/billing accuracy.

• Conduct interviews of providers and/or health plan members in order to determine whether fraud, waste, or abuse may have occurred.

• Coordinate with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations.

• Detect potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.

• Incorporate leadership and communication skills to work with physicians and other health professionals when investigating cases.

• Generate and provide accurate and timely written reports for internal and/external use detailing audit findings.

• Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.

• Identify opportunities for improvement through the audit process and provide recommendations for system enhancement in order to augment investigative outcomes and performance.

**JOB QUALIFICATIONS**

**REQUIRED EDUCATION** :

Graduate from an Accredited School of Nursing.

+ **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

+ Five years clinical nursing experience with broad clinical knowledge.

+ Five years experience conducting medical review and coding/billing audits involving professional and facility based services.

+ Knowledge and understanding of medical terminology along with demonstrated knowledge of CPT, ICD-9, HCPCS and DRG requirements.

+ Two years of managed care experience.

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

Active, unrestricted State Registered Nursing (RN) license in good standing.

**PREFERRED EDUCATION** :

Bachelor’s Degree in Nursing

**PREFERRED EXPERIENCE** :

+ Experience in government programs (i.e., Medicare, Medicaid, & SCHIP).

+ Experience in long-term care.

**STATE SPECIFIC REQUIREMENTS** :

OHIO:

+ Transitions of Care for New Members

+ Molina Healthcare of Ohio follows the transition of care requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from fee-for-service (FFS) or another MCO. The Transition of Care Coach will coordinate all services with new members to ensure a seamless transition and ensure continuity of care.

+ Provision of Member Information

+ Pre-Enrollment Planning

+ The Molina Transition of Care Coach coordinates with and utilizes data provided by ODM, another MCO, the OhioRISE Plan (when applicable) and or collected by Molina (e.g. through assessments, new member outreach in advance of the member’s enrollment effective date) to identify existing sources of care and to ensure each new member is able to continue to receive existing services without disruption.

+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE Plan in pre-enrollment planning

+ Continuation of Services for Members

+ Documentation of Transition of Services

+ Transitions of Care Between Health Care Settings

+ Transitions of Care Between Molina Healthcare of Ohio and the OhioRISE Plan

+ Care Coordination Assignment

+ Provision of Member Information

+ Continuation of Services for Members

+ Documentation of Transition of Services

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: $77,969 - $128,519 / ANNUAL

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

**Job Summary:**

The Ethics and Compliance Group at **onsemi** (“the Company”) oversees compliance with the Company’s Code of Business Conduct, Company policies, as well as the Company’s social compliance commitments to employees, customers and vendors. We are a global, multidisciplinary team that adopts a proactive approach to sourcing information, assessing risk, conducting investigations and recommending process improvements designed to support legal and compliance risk management strategies. The Ethics Investigator will assist senior members of the team in ethics and compliance investigations, as well as other ethics and compliance-related matters under the purview of the Ethics and Compliance Group or other areas of the Legal Department. Over time, the Ethics Investigator should become a subject matter expert representing the Ethics and Compliance Program in various subject matter areas. This position will report to the Head of Ethics and Compliance or as otherwise directed.

**onsemi** (Nasdaq: ON) is driving disruptive innovations to help build a better future. With a focus on automotive and industrial end-markets, the company is accelerating change in megatrends such as vehicle electrification and safety, sustainable energy grids, industrial automation, and 5G and cloud infrastructure. With a highly differentiated and innovative product portfolio, onsemi creates intelligent power and sensing technologies that solve the world’s most complex challenges and leads the way in creating a safer, cleaner, and smarter world.

**More details about our company benefits can be found here:**
https://www.onsemi.com/careers/career-benefits

We are committed to sourcing, attracting, and hiring high-performance innovators, while providing all candidates a positive recruitment experience that builds our brand as a great place to work.

**onsemi** is an Equal Opportunity and Affirmative Action employer. The Company maintains policies and practices that are designed to prevent discrimination or harassment against any qualified applicant or employee to the extent prohibited by federal, state and local laws and regulations. By way of example, discrimination on the basis of race (actual or perceived), ethnicity, color, religion, ancestry, national origin, citizenship, sex, age, marital status, sexual orientation, physical or mental disability, medical condition, genetic information, military or veteran status, gender identity, gender expression, or any other characteristic protected by applicable law is prohibited.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact Talent.acquisition@onsemi.com for assistance.

**Summary:**

The Behavior Integrity Operations team within Integrity and Support Operations focuses on reducing adversarial behavior on Meta Products at scale. In this role, you will conduct technical network investigations to identify, mitigate, and prevent bad actors from abusing the platform. You will investigate holistic networks of abuse to understand and deter adversaries, and then scale solutions that precisely mitigate harm and earn trust with our audiences. You will have the opportunity to influence operations, product, and policy decisions using insights uncovered through data analysis, develop investment strategies to optimize outcomes, and scale solutions to protect Meta users from harm.

**Required Skills:**

Technical Investigator, Integrity Operations Responsibilities:

1. Apply quantitative skills and incorporate qualitative insights to inform and influence strategy for Integrity Operations

2. Investigate complex cases to understand in granular detail how abuse is occurring and attribute the person(s) responsible. Identify and implement appropriate online and offline enforcement strategies to mitigate harm both in the current case and from similar forward-looking abuse.

3. Conduct thorough investigations and Root Cause Analysis to identify community harm trends, build scalable solutions and have direct impact on user harm

4. Partner with Product, Engineering, Data Science and Data Engineering Teams to lead or contribute to large scale cross-functional projects as well as solve ongoing integrity problems at scale.

5. Take a leadership role in suggesting, prototyping, and teaching novel investigative techniques.

6. Identify opportunities to build automation solutions to make Ops processes more efficient

**Minimum Qualifications:**

Minimum Qualifications:

7. 5+ years of work experience in an analytics role involving strategy, problem solving, and/or technical systems

8. Experience using analytics to break down ambiguous, complex problems using data, and drawing actionable insights

9. Experience working in a rapidly-changing environment, leading projects to completion while managing multiple priorities, stakeholders and tight deadlines

10. Experience solving complex problems and operating in ambiguity under your own initiative

11. Proficiency with data querying languages (e.g. SQL), scripting languages (e.g. Python), and/or statistical/mathematical software (e.g. R)

12. Experience explaining technical concepts and analysis implications clearly to varied audiences, translating business objectives into actionable analyses, and presenting complex insights to leadership

13. Bachelor's Degree

**Preferred Qualifications:**

Preferred Qualifications:

14. Experience working in an online operations or trust & safety organization, preferably in the fraud domain

15. Advanced degree with a quantitative focus (Computer Science, Statistics, Finance, Information Systems, Applied Economics or similar technical field) or equivalent practical experience

16. Experience presenting complex data insights to leadership

**Public Compensation:**

$93,000/year to $136,000/year + bonus + equity + benefits

**Industry:** Internet

**Equal Opportunity:**

Meta is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender, gender identity, gender expression, transgender status, sexual stereotypes, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. Meta participates in the E-Verify program in certain locations, as required by law. Please note that Meta may leverage artificial intelligence and machine learning technologies in connection with applications for employment.

Meta is committed to providing reasonable accommodations for candidates with disabilities in our recruiting process. If you need any assistance or accommodations due to a disability, please let us know at accommodations-ext@fb.com.

**JOB DESCRIPTION**

**Job Summary**

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical determinations as necessary, and applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

• Perform objective desk and onsite medical record audits to verify if services were supported by documentation, to determine if services were appropriately administered, and/or to validate coding/billing accuracy.

• Conduct interviews of providers and/or health plan members in order to determine whether fraud, waste, or abuse may have occurred.

• Coordinate with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations.

• Detect potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.

• Incorporate leadership and communication skills to work with physicians and other health professionals when investigating cases.

• Generate and provide accurate and timely written reports for internal and/external use detailing audit findings.

• Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.

• Identify opportunities for improvement through the audit process and provide recommendations for system enhancement in order to augment investigative outcomes and performance.

**JOB QUALIFICATIONS**

**REQUIRED EDUCATION** :

Graduate from an Accredited School of Nursing.

+ **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

+ Five years clinical nursing experience with broad clinical knowledge.

+ Five years experience conducting medical review and coding/billing audits involving professional and facility based services.

+ Knowledge and understanding of medical terminology along with demonstrated knowledge of CPT, ICD-9, HCPCS and DRG requirements.

+ Two years of managed care experience.

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

Active, unrestricted State Registered Nursing (RN) license in good standing.

**PREFERRED EDUCATION** :

Bachelor’s Degree in Nursing

**PREFERRED EXPERIENCE** :

+ Experience in government programs (i.e., Medicare, Medicaid, & SCHIP).

+ Experience in long-term care.

**STATE SPECIFIC REQUIREMENTS** :

OHIO:

+ Transitions of Care for New Members

+ Molina Healthcare of Ohio follows the transition of care requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from fee-for-service (FFS) or another MCO. The Transition of Care Coach will coordinate all services with new members to ensure a seamless transition and ensure continuity of care.

+ Provision of Member Information

+ Pre-Enrollment Planning

+ The Molina Transition of Care Coach coordinates with and utilizes data provided by ODM, another MCO, the OhioRISE Plan (when applicable) and or collected by Molina (e.g. through assessments, new member outreach in advance of the member’s enrollment effective date) to identify existing sources of care and to ensure each new member is able to continue to receive existing services without disruption.

+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE Plan in pre-enrollment planning

+ Continuation of Services for Members

+ Documentation of Transition of Services

+ Transitions of Care Between Health Care Settings

+ Transitions of Care Between Molina Healthcare of Ohio and the OhioRISE Plan

+ Care Coordination Assignment

+ Provision of Member Information

+ Continuation of Services for Members

+ Documentation of Transition of Services

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: $77,969 - $128,519 / ANNUAL

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