Fraud Investigator

Summary

Investigator PositionThe Investigator will be responsible for triaging, investigating and resolving instances of healthcare waste and billing errors conducted by the medical profession, insured members or the broker community. You will be utilizing information from claims data analysis, tips, complaints from plan members, the medical community and law enforcement agencies to conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations. The Investigator may also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation. May also complete root cause analysis.Min USD $77,099.34/Yr.Max USD $92,519.21/Yr.

Job Description

Investigator PositionThe Investigator will be responsible for triaging, investigating and resolving instances of healthcare waste and billing errors conducted by the medical profession, insured members or the broker community. You will be utilizing information from claims data analysis, tips, complaints from plan members, the medical community and law enforcement agencies to conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations. The Investigator may also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation. May also complete root cause analysis.Min USD $77,099.34/Yr.Max USD $92,519.21/Yr.