Orchard · 3 weeks ago
Healthcare Fraud Investigator II - Medicare
Los Alamitos, CA, US
Full-time
Hybrid
Mid, Senior Level
$64K/yr - $80K/yr
2+ years expOrchard LLC is a not-for-profit corporation that partners with public and private sectors to enhance healthcare delivery. The Healthcare Fraud Investigator II role involves ensuring the integrity of claims processes, conducting audits and investigations, and implementing strategies to prevent fraudulent activities.
AgTechArtificial Intelligence (AI)FarmingRobotics
Responsibilities
Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity
Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed
Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements
Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process
Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims
Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards
Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates
Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes
Qualification
Required
Minimum Bachelor's Degree
Minimum of 2-4 years experience in healthcare fraud investigation/detection; 5-7 years experience preferred
Must possess prior experience in federal or state healthcare programs or a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions related to fraud, waste and abuse
Preferred
Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator
Prior successful experience with CMS and OIG/FBI or similar agencies
Medicare investigation experience strongly preferred
Company
Orchard
We're a team of engineers, researchers, and farmers on a mission to revolutionize one of Earth's most important industries – agriculture.
11-50 employees
Funding
Current Stage
Early StageTotal Funding
$25.8MKey Investors
General CatalystContrary
2025-09-03Series A· $22M
2024-03-27Seed· $3.2M
2022-03-01Pre Seed· $0.6M
Leadership Team
Charlie Wu
CEO & Founder
Recent News
Soma Capital
2026-01-21
2025-10-16
Company data provided by crunchbase