Fraud Investigator - CPC Certified

Job Summary

Contributing to in-depth investigations of suspected fraud and abuse, the full-time remote Fraud Investigator - CPC Certified will analyze claims, conduct interviews, and perform audits while ensuring compliance with health plan policies.

Key responsibilities:

• Identify, investigate, and evaluate instances of potential fraud, waste, and abuse
• Conduct interviews with relevant parties to determine settlement or review outcomes
• Analyze investigation findings and prepare written summaries or presentations

Required qualifications:

• Bachelor's degree preferred
• Certified Professional Coder (CPC) preferred or to be achieved within 12 months of hire
• 2 years of combined experience in Internal/External Audit, regulatory/compliance, or healthcare preferred