Fraud Investigator

Job Summary

Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will review referrals, claims data, and medical records to identify potential misconduct while collaborating with various stakeholders in a remote setting.

Key responsibilities

• Conducts investigations using claims data, medical records, and interviews to identify potential fraud and support case resolution
• Prepares investigative reports and collaborates with internal and external partners to coordinate investigative activities and support corrective actions
• Maintains compliance with federal and state regulations while monitoring for emerging fraud schemes and billing irregularities

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, waste, and abuse investigations 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