Claims investigator Jobs in Arvada, CO

Compliance Investigator

Hybrid schedule: Required to be in-office on Tuesdays and Wednesdays during core hours (8:00 AM 5:00 PM), with additional in-office days as needed for meetings, training, and events.

Denver, CO

Compliance Investigator, responsible for conducting investigations on compliance related matters submitted through DaVita's compliance hotline or other reporting avenues. Investigations include potential compliance policy or federal healthcare law-related matters, including Anti-Kickback Statute, False Claims Act, and other laws and regulations related to healthcare compliance. The Compliance Investigator will coordinate with other DaVita departments, including legal and human resources, to handle all aspects of investigations, including gathering relevant documentation, conducting interviews, documenting investigations, and recommending corrective action as necessary.

The Compliance Investigator is responsible for conducting comprehensive compliance investigations across various business areas. The role involves gathering and analyzing data, interviewing stakeholders, performing process analysis, and maintaining detailed documentation. This position requires sound judgment, effective decision-making, and the ability to influence stakeholders and manage complex situations. The ideal candidate will prioritize tasks, manage a significant caseload, and collaborate with colleagues across departments to ensure compliance standards are upheld.

Key Responsibilities:

Conduct thorough compliance investigations across business areas, including interviews, data analysis, process reviews, follow-up, and documentation.

Analyze factual findings to determine appropriate case disposition and ensure timely follow-up.

Influence decision-making processes, manage difficult conversations, and recommend or enforce corrective actions when necessary.

Prioritize and manage a large caseload, ensuring timely resolution of all investigative matters.

Maintain comprehensive case files and provide clear and concise summaries of investigative findings and conclusions.

Collaborate regularly with colleagues across departments to facilitate investigations and implement corrective actions where needed.

Provide regular written and verbal updates to leadership on investigation progress and outcomes.

Partner with other DaVita compliance functions and departments to drive overall compliance initiatives across the organization.

Assist with additional projects and tasks related to the investigative functions as required.

Occasional travel may be required (up to 10%).

Minimum Qualifications:

Education: Bachelor's degree required; Master's or Law degree or relevant clinical experience preferred, though not required.

Experience: A minimum of five (5) years of experience leading or conducting internal investigations; healthcare compliance investigations experience preferred.

Knowledge: Familiarity with federal fraud and abuse laws is preferred.

Proven Track Record: A history of progressively responsible roles in healthcare organizations, law firms, and/or federal or state health care or enforcement agencies.

Skills:

o Exceptional organizational skills with keen attention to detail.

o Strong time management abilities and the capability to prioritize and meet deadlines in a fast-paced environment.

o Excellent problem-solving and decision-making skills with the ability to identify issues, propose solutions, and implement corrective actions.

o Ability to work independently as well as collaboratively in a team environment, effectively managing projects and delegating tasks when needed.

o Strong interpersonal skills, with the ability to interact effectively at all organizational levels.

o High level of discretion and ability to handle confidential information with sensitivity.

Preferred Experience: Experience working with NAVEX and EthicsPoint compliance systems.

Working Conditions:

Hybrid schedule: Required to be in-office on Tuesdays and Wednesdays during core hours (8:00 AM 5:00 PM), with additional in-office days as needed for meetings, training, and events.

Must be able to thrive in a fast-paced environment and manage multiple priorities simultaneously.

Occasional travel for meetings, audits, and other business-related activities may be required.