Fraud Investigation Specialist
Job Summary
Conducting thorough fraud, waste, and abuse (FWA) investigations, the full-time Special Investigation Unit Investigator will review claims data, medical records, and provider information while collaborating with stakeholders to ensure compliance and support case resolution in a remote setting.
Key responsibilities
- Conducts FWA investigations using various data sources to identify potential misconduct
- Prepares investigative reports and collaborates with internal and external partners to support case resolution
- Monitors emerging fraud schemes and recommends actions for further review
Required qualifications
- Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or related field, or equivalent experience
- Minimum of five years in the healthcare field focusing on fraud investigations or insurance claims
- Experience analyzing healthcare claims, medical records, and related documentation
- Preferred certifications include Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)
- Experience with audits and compliance standards in healthcare settings is preferred
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 41,048 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
Wikipedia Wikipedia URL
BBB URL BBB URL
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
