Fraud Investigator Certification Required (16)

Summary

Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and other evidence to identify misconduct and support case resolution while working remotely.Key responsibilitiesConducts investigations utilizing referrals, claims data, and interviews to identify potential misconductPrepares investigative reports and collaborates with internal and external stakeholders to support case resolutionMaintains compliance with federal and state regulations while monitoring for emerging fraud schemesRequired qualificationsBachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field, or equivalent experience2+ years of experience in fraud, waste, and abuse investigations or related investigative fieldsExperience analyzing healthcare claims, medical records, and billing documentation preferredAccredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or related certification preferred

Job Description

Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and other evidence to identify misconduct and support case resolution while working remotely.Key responsibilitiesConducts investigations utilizing referrals, claims data, and interviews to identify potential misconductPrepares investigative reports and collaborates with internal and external stakeholders to support case resolutionMaintains compliance with federal and state regulations while monitoring for emerging fraud schemesRequired qualificationsBachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field, or equivalent experience2+ years of experience in fraud, waste, and abuse investigations or related investigative fieldsExperience analyzing healthcare claims, medical records, and billing documentation preferredAccredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or related certification preferred