Special Investigations Unit Coordinator (Bilingual Vietnamese, Korean or Mandarin)

Job Details

Job Location

Arcadia Office - Arcadia, CA

Position Type

Full Time

Description

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? ✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us? 🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The SIU Coordinator plays a vital role in supporting the Special Investigations Unit by handling administrative and coordination tasks related to fraud, waste, and abuse (FWA) investigations. The SIU Coordinator is responsible for maintaining accurate records, assisting with data entry and case management, and facilitating communication between investigators, internal departments, and external agencies. This role is ideal for an organized professional with strong attention to detail and an interest in learning more about health care fraud, waste and abuse investigations.

Functions & Job Responsibilities

• Assist SIU staff with the coordination and organization of case files, documentation, and investigative reports.
• Assist in preparing and sending communications to providers and members, including audit results letters, medical records requests, and other correspondence related to investigations.
• Support the intake and triage process for potential fraud, waste, and abuse referrals by gathering initial information and ensuring accurate data entry.
• Assist SIU staff in conducting onsite audits of providers, facilities, and other entities by gathering necessary documentation and supporting the collection of evidence to identify potential fraud, waste, and abuse activities.
• Maintain and update SIU case management systems, ensuring that all case information is accurately recorded and tracked.
• Assist with data analysis, report generation, and the preparation of materials for regulatory audits, internal reviews, or meetings with senior leadership.
• Prepare and distribute routine correspondence, reports, and notifications related to ongoing investigations and case outcomes.
• Coordinate meetings, interviews, and appointments for SIU team members, including internal staff and external stakeholders.
• Act as a liaison between the SIU and other departments (e.g., Claims, Compliance, Provider Network) to facilitate the flow of information related to investigations.
• Maintain confidentiality of all investigative activities and handle sensitive information in accordance with HIPAA and company policies.
• Assist in preparing training materials and presentations to support fraud awareness initiatives.
• Support the development and implementation of policies, procedures, and best practices related to fraud detection and investigation.
• Performs other duties as assigned.
  
  

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Qualifications

Required Qualifications

• Associate degree or equivalent combination of education and experience. Bachelor’s Degree preferred.
• 1-3 years of experience in an administrative or coordination role, preferably within a health plan, health care environment, or insurance setting.
• Basic understanding of health care fraud, waste, and abuse concepts, or a willingness to learn.
• Must have valid driver’s license to be able to travel when needed or required to conduct onsite audits
  
  

Required Skills

• Strong organizational and time-management skills with the ability to manage multiple tasks and prioritize effectively.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and experience with data entry or case management systems.
• Excellent written and verbal communication skills.
• High level of attention to detail and accuracy in handling data and documentation.
• Knowledge of health care regulations (e.g., HIPAA, CMS guidelines)
• Detail-oriented, self-motivated, able to meet tight deadlines
• Initiative, excellent follow-through, persistence in locating and securing needed information
• Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities
• Ability to handle confidential information with integrity and discretion.
• Energetic and forward thinking with high ethical standards
• Collaborative and team-oriented
  
  

Preferred Qualifications

• Familiarity with health care claims processes, medical terminology, or insurance billing practices is a plus.
• Certificates /designations and/or training in healthcare fraud and abuse investigations
• Certified Health Care Anti-Fraud Associate (HCAFA)
• Experience with HIPAA, data privacy, and/or data security processes
• Experienced at interfacing with national and regional CMS offices preferred.
• Experience working with regulators governing (public or private) health insurance carriers
  
  

Wage Range: $20.00/hr to $28.00/hr

Physical & Working Environment.

• Must be able to travel when needed or required to conduct onsite audits
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.
• Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.
• Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and other individuals. May occasionally be required to work irregular hours based on the needs of the business.
  
  

Disclaimer

The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.