Fraud Investigator (49)

Summary

Conducting comprehensive fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with stakeholders to support case resolution in a remote setting.Key responsibilitiesConducts investigations utilizing various resources to identify potential misconduct and support case resolutionPrepares investigative reports, case summaries, and referrals for internal and external stakeholdersCollaborates with compliance, legal, and provider teams to coordinate investigative activities and support corrective actionsRequired qualificationsBachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience5+ years of experience in healthcare fraud, waste, and abuse investigations or insurance claims investigationsExperience analyzing healthcare claims, medical records, and billing documentation preferred

Job Description

Conducting comprehensive fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with stakeholders to support case resolution in a remote setting.Key responsibilitiesConducts investigations utilizing various resources to identify potential misconduct and support case resolutionPrepares investigative reports, case summaries, and referrals for internal and external stakeholdersCollaborates with compliance, legal, and provider teams to coordinate investigative activities and support corrective actionsRequired qualificationsBachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience5+ years of experience in healthcare fraud, waste, and abuse investigations or insurance claims investigationsExperience analyzing healthcare claims, medical records, and billing documentation preferred