Fraud Investigator

Job Summary

Conducting comprehensive fraud, waste, and abuse (FWA) investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with internal and external stakeholders to support case resolution and ensure compliance with regulations in a remote work environment.

Key responsibilities

• Conducts FWA investigations using various data sources to identify misconduct and support case resolution
• Prepares investigative reports and collaborates with internal and external partners to coordinate investigative activities
• Monitors for emerging fraud schemes and recommends actions for further review

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience
• 2+ years of experience in fraud investigations, healthcare investigations, claims audits, or related fields
• Experience analyzing healthcare claims, medical records, and billing documentation preferred
• Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or similar certification preferred