Certified Fraud Investigator

Job Summary

To support the investigation of healthcare fraud, the full-time Certified Fraud Investigator will conduct confidential inquiries, analyze trends, and collaborate with various stakeholders while working remotely from anywhere within the U.S.

Key responsibilities:

• Perform root-cause and trend analysis to develop prevention strategies and policy recommendations
• Gather relevant facts and compile investigation summaries and compliance packages
• Provide mentorship to investigators and analysts, ensuring adherence to documentation standards and case outcomes

Required qualifications:

• High School Diploma / GED
• Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
• 5+ years of experience in fraud investigations or FWA/SIU roles
• 2+ years of experience in the health insurance claims industry
• Intermediate proficiency in Microsoft Excel and Word