CPC Certified Senior SIU Investigator

Job Summary

To manage comprehensive fraud, waste, and abuse investigations, the full-time remote CPC Certified Senior SIU Investigator will develop investigative strategies, analyze data, and prepare detailed reports while collaborating with various stakeholders.

Key responsibilities

• Conduct and manage fraud investigations, including audits and data analysis, to identify suspicious patterns and ensure compliance with regulations
• Prepare detailed investigatory reports and present findings to internal departments, law enforcement, and regulatory agencies
• Provide guidance and training to SIU Investigators and recommend process improvements to enhance departmental efficiency

Required qualifications

• Minimum of 7 years of experience in fraud investigations or related healthcare insurance roles
• Bachelor's degree or a combination of education and work experience
• CPC certification is required
• Proven ability to manage and prioritize a caseload independently
• Strong computer skills, including proficiency in Microsoft Excel, Access, Outlook, Word, and PowerPoint