Fraud Investigator

Job Summary

Identifying and analyzing potential fraud within healthcare claims, the full-time remote Fraud Investigator will document findings, collaborate with teams to build cases, and prepare reports while adhering to regulatory and ethical standards.

Key responsibilities

• Review large data sets and claim files to detect patterns of suspicious activity
• Gather and assess evidence, maintaining thorough records of investigations
• Prepare summary reports and communicate findings to stakeholders and clients

Required qualifications

• Experience in fraud prevention and investigations, with a focus on healthcare claims
• Strong analytical skills and ability to interpret complex financial or healthcare data
• Knowledge of finance principles relevant to claims and overpayment recovery
• Familiarity with law enforcement or regulatory frameworks related to fraud investigations
• Bachelor's degree in criminal justice, finance, accounting, healthcare administration, or a related field is preferred