Fraud Investigator Certification Required

Job Summary

Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and other evidence to identify misconduct and support case resolution while working remotely.

Key responsibilities

• Conducts investigations utilizing referrals, claims data, and interviews to identify potential misconduct
• Prepares investigative reports and collaborates with internal and external stakeholders to support case resolution
• Maintains compliance with federal and state regulations while monitoring for emerging fraud schemes

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 investigative fields
• Experience analyzing healthcare claims, medical records, and billing documentation preferred
• Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or related certification preferred