Fraud Investigator

Job Summary

Conducting comprehensive fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with stakeholders to support case resolution in a remote setting.

Key responsibilities

• Conducts investigations utilizing various resources to identify potential misconduct and support case resolution
• Prepares investigative reports, case summaries, and referrals for internal and external stakeholders
• Collaborates with compliance, legal, and provider teams to coordinate investigative activities and support corrective actions

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 5+ years of experience in healthcare fraud, waste, and abuse investigations or insurance claims investigations
• Experience analyzing healthcare claims, medical records, and billing documentation preferred