JOB DESCRIPTION Job Summary Provides investigative support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA). Responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care, and recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. Essential Job Duties • Responsible for developing leads presented to the special investigation unit (SIU) to assess and determine whether potential fraud, waste, or abuse (FWA) is corroborated by evidence. • Conducts both preliminary assessments of FWA allegations, and end-to-end investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, recommendations and preparation of overpayment identifications, and closure of investigative cases. • Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. • Conducts both on-site and desktop investigations. • Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential FWA. • Performs accurate and reliable medical review audits that may also include coding and billing reviews. • Produces audit reports for internal and external review. • Coordinates with various internal customers (e.g., provider services, contracting and credentialing, healthcare services, member services, claims, etc.), to gather documentation pertinent to investigations. • Detects potential health care FWA through the identification of aberrant coding and/or billing patterns through utilization review. • Prepares appropriate FWA referrals to regulatory agencies and law enforcement. • Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. • Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when FWA is identified as required by regulatory and/or contract requirements. • Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. • Interacts with regulatory and/or law enforcement agencies regarding case investigations. • Prepares audit results letters to providers when overpayments are identified. • Ensures compliance with applicable contractual requirements, and federal and state regulations. • Complies with SIU policies as and procedures as well as goals set by SIU leadership. • Supports SIU in arbitrations, legal procedures, and settlements. • Actively participates in Medicaid Fraud Control Unit (MFCU) meetings and roundtables on FWA case development and referrals. • May work with other internal departments, including compliance, corporate legal counsel, and medical affairs to achieve and maintain appropriate anti-fraud oversight. Required Qualifications • At least 2 years of investigative experience in the health care industry, or equivalent combination of relevant education and experience. • Valid and unrestricted driver’s license. • Proven investigatory skills including ability to organize, analyze, and effectively determine risk with corresponding solutions, and remain objective and separate facts from opinions. • Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. • Knowledge of managed care and Medicaid, Medicare, and Marketplace programs. • Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. • Understanding of datamining and use of data analytics to detect FWA. • Ability to research and interpret regulatory requirements. • Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. • Strong presentation skills with ability to create and deliver training, informational and other types of programs. • Strong logical, analytical, critical-thinking and problem-solving skills. • Strong sense of initiative, excellent follow-through, and persistence in locating and securing needed information. • Fundamental understanding of audits and corrective actions. • Ability to multi-task and operate effectively across geographic and functional boundaries. • Detail-oriented, self-motivated, and able to meet tight deadlines. • Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. • Energetic and forward-thinking with high ethical standards and a professional image. • Collaborative and team-oriented. • Effective verbal and written communication skills. • Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications • Experience in government programs (i.e., Medicare, Medicaid, Marketplace). • Experience in FWA or related work. • Accredited Health Care Fraud Investigator (AHFI) and/or Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Company Description If you are looking to join a global company with a family feel, you'll find your perfect fit at Skyward, where we build software solutions for K-12 schools. Just imagine getting to help students, teachers, and school administrators succeed every day — you can't say that about every job! We take great pride in our work, but also in our work environment: teamwork, enthusiasm, continuous improvement, and, of course, a bit of fun. When you join our team there is only one way your career will go - Skyward!  To learn more about Skyward’s careers, history, products, and customers, go to www.skyward.com.   Thank you for your interest! Job Description Job Title: State & Federal Compliance Analyst Location: Stevens Point, WI - Corporate Office *May include remote opportunities in the following states: AZ, FL, IL, IN, KS, MI, MN, PA, TN, TX, UT, WA, WI. No relocation assistance is provided. Starting Salary: $49,352.06 - $54,287.27 (wage to commensurate with experience)   Are you passionate about education, compliance, and technology? Do you thrive in a role that blends research, communication, and software expertise? If so, we want you on our team! Skyward is seeking a State & Federal Compliance Analyst to ensure our software meets evolving state and federal reporting requirements. This role is ideal for someone who enjoys digging into regulations, collaborating across teams, and making a real impact in the education technology space. Click here for a full job description. What you'll do: - Research and interpret state and federal reporting requirements. - Communicate changes to internal teams and customers. - Conduct quality assurance testing and compliance training. - Assist support teams with troubleshooting reporting-related issues. - Create and maintain documentation and training materials. - Verify data migration from third-party software. - Collaborate with product development to ensure compliance is built into our solutions. What you'll need: - A 2-year or 4-year degree, or equivalent experience in school administrative software, state reporting, or compliance research. - Strong interpersonal and communication skills. - Proficiency in Microsoft Office (Excel, Word, PowerPoint). - Analytical mindset with attention to detail. - Ability to work independently and manage multiple priorities. Skyward’s Benefits: At Skyward, we believe in supporting our team members both personally and professionally. Visit our Employee Benefits page for more information on the following offerings: - Paid time off - 8.5 paid holidays - 401(k) retirement plan with company match - Health, dental, and vision coverage - Company sponsored basic life/AD&D, short-term, and long-term disability - Employee Assistance Program - A robust wellness program Want to learn more about this department and the skills it takes to succeed as a member of the Skyward team? Spend some time on our careers page at https://www.skyward.com/careers. You'll learn more about our culture, expectations, and even the day-to-day mission of the department you're applying for.  A better working experience starts here!  Additional Information All your information will be kept confidential according to EEO guidelines. Skyward, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants have rights under Federal Employment Laws. Click the title to view details about the law. - Family and Medical Leave Act (FMLA) - Equal Employment Opportunity (EEO) - Employee Polygraph Protection Act (EPPA) - Transparency in Coverage - Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes these Machine-Readable Files on behalf of Skyward. - Department: Compliance - Starting Salary: $49,352.06 - $54,287.27 - Employment Status: Full-Time - FLSA Status: Hourly Non-Exempt

Role Description Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information. - Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions. - Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare. - Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. Qualifications - High School Diploma or GED. - Experience in a production or administrative role requiring self-direction and critical thinking. - Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems. - Experience with professional written and verbal communication. Requirements - Experience in the health care industry. - Experience with Provider credentialing. Benefits - Molina Healthcare offers a competitive benefits and compensation package.

• Implement and continuously improve Sungrow's compliance program across European entities, ensuring adherence to all applicable laws and internal policies. • Conduct proactive compliance risk assessments across business functions, identifying potential gaps and proposing effective mitigation strategies. • Develop and deliver impactful compliance training programs to employees and management, fostering a strong culture of compliance. • Support rigorous compliance with EU sanctions, export control regulations, trade compliance rules, and anti-corruption measures. • Assist with compliance pertaining to EU Foreign Subsidies Regulation (FSR) and EU International Procurement Instrument (IPI/IAA), coordinating internal information gathering for regulatory inquiries. • Contribute to the company’s ESG initiatives and supply chain due diligence, ensuring adherence to sustainability and responsible sourcing regulations. Conduct thorough compliance due diligence on third parties, including distributors, suppliers, and agents, to identify and mitigate legal, regulatory, or reputational risks.