Fraud Investigation Senior Analyst

Job Summary

Assisting in the detection and investigation of fraud, waste, and abuse, the full-time salaried Fraud Investigation Senior Analyst will review claims data, conduct investigations, and collaborate with regulatory agencies while working remotely.

Key responsibilities

• Leverage analytical skills to review claims data and identify patterns of suspected fraud, waste, and abuse
• Assist in the triage and preliminary investigation of internal and external fraud complaints, ensuring compliance with documentation standards
• Participate in prepayment reviews and produce detailed investigative reports based on findings

Required qualifications

• 3-5 years of work experience in a relevant field
• CPC or equivalent coding certification
• Working knowledge of standard industry coding guidelines such as CPT, HCPCs, and ICD-10
• Experience reviewing medical records to ensure documentation matches services billed
• Experience interpreting detailed claims data