Fraud Investigator III

Job Summary

A company is looking for an Investigator III to lead complex investigations into allegations of fraud, waste, and abuse in healthcare.

Key Responsibilities

• Analyze healthcare claim data to detect fraudulent activity and determine investigation methods
• Conduct investigative fieldwork including office visits, record collection, and surveillance
• Prepare cases for potential criminal prosecution and participate in settlement negotiations

Required Qualifications and Education

• Bachelor's degree in business administration, healthcare administration, finance, accounting, nursing, or criminal justice, or 4 years of relevant work experience
• 3 years of experience in fraud investigation or a related field
• Certification as a Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI)
• 2 years of active experience in auditing and investigating within the healthcare industry
• Significant experience with relevant technology, including fraud detection software and claims processing platforms