Junior Medicaid Fraud Investigator (35)

Summary

Working fully remote, the full-time Junior Healthcare Fraud, Waste & Abuse (FWA) Investigator will assist the Medicaid Special Investigations Unit (SIU) in reviewing claims, medical records, and provider activities to identify potential fraud, waste, and abuse while participating in the investigative lifecycle.Key ResponsibilitiesConduct SIU investigations involving Medicaid fraud, waste, and abuse across various healthcare entitiesReview and analyze Medicaid claims data to identify unusual billing patterns and potential FWA indicatorsPrepare clear investigative notes, case summaries, and documentation while maintaining organized investigative filesRequired QualificationsBachelor's degree in healthcare, criminal justice, business, finance, public health, or a related field1-3 years of experience in healthcare, claims, medical billing/coding, auditing, compliance, or investigationsProficiency with Microsoft Office, particularly Excel and WordAbility to work independently in a fully remote environment while collaborating with a distributed teamStrong analytical skills and attention to detail in evaluating large volumes of information

Job Description

Working fully remote, the full-time Junior Healthcare Fraud, Waste & Abuse (FWA) Investigator will assist the Medicaid Special Investigations Unit (SIU) in reviewing claims, medical records, and provider activities to identify potential fraud, waste, and abuse while participating in the investigative lifecycle.Key ResponsibilitiesConduct SIU investigations involving Medicaid fraud, waste, and abuse across various healthcare entitiesReview and analyze Medicaid claims data to identify unusual billing patterns and potential FWA indicatorsPrepare clear investigative notes, case summaries, and documentation while maintaining organized investigative filesRequired QualificationsBachelor's degree in healthcare, criminal justice, business, finance, public health, or a related field1-3 years of experience in healthcare, claims, medical billing/coding, auditing, compliance, or investigationsProficiency with Microsoft Office, particularly Excel and WordAbility to work independently in a fully remote environment while collaborating with a distributed teamStrong analytical skills and attention to detail in evaluating large volumes of information