California Department of Justice · 3 hours ago
Auditor I
San Diego County, CA
Full-time
Hybrid
New Grad, Entry Level
$4,256/mo - $5,600/moThe California Department of Justice is dedicated to fighting healthcare fraud and protecting the Medi-Cal Program. The Auditor I role involves conducting complex civil audits and investigations, analyzing claims data, and collaborating with various stakeholders to combat fraud and recover stolen funds.
Law EnforcementNon Profit
Responsibilities
Conducts complex civil audits and investigations for the Civil Section, including:
Work with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys to combat global health fraud. Review and provide claims data of suspected activity and assist in civil remediation
Obtains and analyzes information from Medi-Cal claims database(s) and other evidence obtained from a variety of sources associated with cases and complaints of alleged Medi-Cal provider fraud
Identifies, gathers, and maintains voluminous data relevant to such allegations
Estimating and calculating monetary losses to the Medi-Cal program, including determining the reasonableness of audit findings and evaluating such results through comparative analysis and independent third-party verification
Conducting interviews, performing any and all fieldwork needed for the audit or investigation, compiling and evaluating competent evidentiary material, developing audit findings, preparing detailed reports of investigation and schedules of findings that result from investigative activities and records examinations
Participating in meetings, depositions, and interviews with qui tam relators, investigative, legal, and managerial staff, as well as private law firms and various governmental agencies
Developing forensic investigative strategies and identifying resources necessary to perform various audit and investigative assignments
Collaborating with teams of attorneys, paralegals, support staff, investigators, agents and auditors, and other analysts both within and beyond the Division
Utilizing computerized audit techniques with tools including MIS/DSS claims database, Business Objects, Medi-Cal Management Information System, Lexis-Nexis, Microsoft Office Suite, SAS Enterprise Guide to develop programs and other information for sampling, cost evaluations, determining patterns, and trend analysis
Assisting in the preparation (including drafting) and service of subpoenas, as well as in the preparation of discovery requests and discovery responses
Assisting in the preparation of matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials both in person and by affidavit
Qualification
Required
Superlative data management and investigative skills
Commitment to detecting and combating fraud
Ability to conduct complex civil audits and investigations
Experience working with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys
Ability to review and provide claims data of suspected activity and assist in civil remediation
Ability to obtain and analyze information from Medi-Cal claims database(s) and other evidence
Skill in identifying, gathering, and maintaining voluminous data relevant to allegations of fraud
Ability to estimate and calculate monetary losses to the Medi-Cal program
Experience determining the reasonableness of audit findings and evaluating results through comparative analysis and independent third-party verification
Ability to conduct interviews and perform fieldwork needed for audits or investigations
Skill in compiling and evaluating competent evidentiary material
Ability to develop audit findings and prepare detailed reports of investigation and schedules of findings
Experience participating in meetings, depositions, and interviews with various stakeholders
Ability to develop forensic investigative strategies and identify necessary resources for audit and investigative assignments
Experience collaborating with teams of attorneys, paralegals, support staff, investigators, agents, auditors, and other analysts
Skill in utilizing computerized audit techniques with tools including MIS/DSS claims database, Business Objects, Medi-Cal Management Information System, Lexis-Nexis, Microsoft Office Suite, SAS Enterprise Guide
Ability to assist in the preparation and service of subpoenas, as well as in the preparation of discovery requests and responses
Experience assisting in the preparation of matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials
Benefits
Work-life balance
11 paid holidays
Flexible paid leave options
Consistent wage increases
Pension retirement
Job stability
Health/Dental/Vision Insurance
Public Service Loan Forgiveness (PSLF) and more!
Company
California Department of Justice
California Department of Justice is a non profit Law Enforcement agency.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Hamid Formoli
Founder/Co-Chair-Middle Eastern and South Asian Employee Advisory Committee
Weslee Howell
Organization Development Partner - Office of Human Resources
Recent News
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