Senior Fraud Investigator (5)

Summary

Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns of fraud, prepare detailed reports, and collaborate with clients and internal teams while mentoring junior staff.Key responsibilitiesAnalyze large data sets to detect potential fraud, waste, and abuse in healthcare billing and claimsPrepare detailed reports and develop citation guidebooks to support consistent and defensible findingsCollaborate with clients and internal audit teams, contributing to case-building efforts and legal proceedingsRequired qualificationsStrong background in fraud prevention and investigations, preferably in healthcare or insuranceAdvanced analytical skills and experience with data analytics tools and statistical sampling methodsKnowledge of finance and reimbursement processes, including billing and overpayment recoveryBachelor's degree in criminal justice, finance, healthcare administration, or a related field; advanced degrees or certifications are a plusFamiliarity with HIPAA, OIG guidelines, and healthcare compliance frameworks

Job Description

Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns of fraud, prepare detailed reports, and collaborate with clients and internal teams while mentoring junior staff.Key responsibilitiesAnalyze large data sets to detect potential fraud, waste, and abuse in healthcare billing and claimsPrepare detailed reports and develop citation guidebooks to support consistent and defensible findingsCollaborate with clients and internal audit teams, contributing to case-building efforts and legal proceedingsRequired qualificationsStrong background in fraud prevention and investigations, preferably in healthcare or insuranceAdvanced analytical skills and experience with data analytics tools and statistical sampling methodsKnowledge of finance and reimbursement processes, including billing and overpayment recoveryBachelor's degree in criminal justice, finance, healthcare administration, or a related field; advanced degrees or certifications are a plusFamiliarity with HIPAA, OIG guidelines, and healthcare compliance frameworks