Fraud Investigator - CPC Certified (1)

Summary

Contributing to in-depth investigations of suspected fraud and abuse, the full-time remote Fraud Investigator - CPC Certified will analyze claims, conduct interviews, and perform audits while ensuring compliance with health plan policies.Key responsibilities:Identify, investigate, and evaluate instances of potential fraud, waste, and abuseConduct interviews with relevant parties to determine settlement or review outcomesAnalyze investigation findings and prepare written summaries or presentationsRequired qualifications:Bachelor's degree preferredCertified Professional Coder (CPC) preferred or to be achieved within 12 months of hire2 years of combined experience in Internal/External Audit, regulatory/compliance, or healthcare preferred

Job Description

Contributing to in-depth investigations of suspected fraud and abuse, the full-time remote Fraud Investigator - CPC Certified will analyze claims, conduct interviews, and perform audits while ensuring compliance with health plan policies.Key responsibilities:Identify, investigate, and evaluate instances of potential fraud, waste, and abuseConduct interviews with relevant parties to determine settlement or review outcomesAnalyze investigation findings and prepare written summaries or presentationsRequired qualifications:Bachelor's degree preferredCertified Professional Coder (CPC) preferred or to be achieved within 12 months of hire2 years of combined experience in Internal/External Audit, regulatory/compliance, or healthcare preferred