$100,000 - $115,000 yearly
San Francisco Health Plan
San Francisco, CA
Investigator, Program Integrity Reporting to the Director, Compliance and Oversight, the Investigator, Program Integrity supports the San Francisco Health Plan (SFHP) Compliance Program through fraud, waste, and abuse investigations, audits, and monitoring activities. The Investigator independently manages and prioritizes a caseload of internally and externally generated leads, conducting objective, fair, thorough, and timely investigations and synthesizing evidence into professional reports with findings and recommendations.
The role conducts routine and focused provider and member audits and monitoring events, supports the coordination of external audits, and contributes to the Annual Program Integrity Workplan and the Medicare D-SNP Program Integrity framework. This work requires sound judgement, rigorous data analysis, and clear communication with staff, management, and external partners to strengthen SFHP's internal control structure and mitigate compliance risk.
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