Florida Licensed SIU Investigator (39)

Summary

To support fraud detection efforts, the full-time Florida Licensed SIU Investigator will conduct field and desk investigations on high complexity claims, focusing on staged auto accidents and questionable medical treatments while working remotely from the Orlando area.Key responsibilities:Conduct in-depth investigations and examinations under oath to gather evidence on suspected fraud casesPrepare comprehensive investigative reports and maintain assigned investigation filesCollaborate with internal and external stakeholders, including law enforcement and medical professionals, to enhance investigation processesRequired qualifications:Associate or bachelor's degree in a related field preferred, along with 5 years of relevant work experienceBilingual in English and SpanishIn-depth knowledge of fraud statutes, regulations, and industry best practicesExpertise in medical claims processing and familiarity with CPT codes and medical terminologyStrong analytical and critical thinking skills with proficiency in data interpretation

Job Description

To support fraud detection efforts, the full-time Florida Licensed SIU Investigator will conduct field and desk investigations on high complexity claims, focusing on staged auto accidents and questionable medical treatments while working remotely from the Orlando area.Key responsibilities:Conduct in-depth investigations and examinations under oath to gather evidence on suspected fraud casesPrepare comprehensive investigative reports and maintain assigned investigation filesCollaborate with internal and external stakeholders, including law enforcement and medical professionals, to enhance investigation processesRequired qualifications:Associate or bachelor's degree in a related field preferred, along with 5 years of relevant work experienceBilingual in English and SpanishIn-depth knowledge of fraud statutes, regulations, and industry best practicesExpertise in medical claims processing and familiarity with CPT codes and medical terminologyStrong analytical and critical thinking skills with proficiency in data interpretation