Intake Investigator at Orchard LLC in Los Alamitos, California

Job Description:

Intake Investigator

Hybrid work schedule in Los Alamitos, CA / Dallas, TX / Easton, MD


@Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high-quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste, and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.


As an Intake Coordinator, independently performs in-depth evaluation and makes field-level judgments related to complaints and proactive leads of potential Medicare fraud investigations that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action. This position is hybrid 2 days onsite in any of the following locations Los Alamitos, CA / Dallas, TX / Easton, MD. The company offers an excellent benefits package with health insurance, two retirement plans, generous vacation and sick leave accruals, and opportunities for advancement.

The Intake Investigator's duties and responsibilities include the following but are not limited to:

• Enters investigative information into the case tracking systems and will meet with Lead Investigators to assign investigations to the Investigative team.
• Works with the team to prioritize complaints for investigations.
• Places potential fraudulent providers on prepay review and monitors adjudication of claims.
• Analyzes data for appropriateness of fraud, waste, and abuse issues in accordance with pre-established criteria, requesting additional documentation if necessary.
• Refers all potential adverse decisions to the Lead Investigator/Manager.
• Identifies, collects, preserves, analyzes, and summarizes the evidence, examines records, verifies the authenticity of documents, prepares affidavits, or supervises the preparation of affidavits as needed.
• Drafts and evaluates investigation reports and promotes effective and efficient investigations.
• Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
• Testifies at various legal proceedings as necessary.
• Communicates with beneficiaries and providers as needed to resolve beneficiary complaints and assists providers with medical review status.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.

Education and/or Experience Required:

• An Associate's Degree and 2 years of experience in a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions or an equivalent combination of education and experience
• Experience in healthcare programs or fraud investigation/detection is preferred.
• Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator is preferred.
• Experience in federal or state healthcare programs is preferred.
• Experience in a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions is preferred.

The anticipated hourly pay for the position is between $22.75-$29.56 depending on location and experience.


Established in 2010, @Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atorchard.com. Apply Now