Fraud Investigator IV

Job Summary

Conducting research and data analysis, the full-time salaried Fraud Investigator IV will identify potential fraud, waste, and abuse (FWA) through extensive data mining and reporting, while working remotely.

Key responsibilities:

• Identify trends and patterns in healthcare data to support fraud investigations and quality improvement initiatives
• Generate and present data analyses and graphics to communicate findings to relevant stakeholders
• Collaborate with legal teams and monitor emerging fraud trends to develop actionable strategies for risk mitigation

Required qualifications:

• Bachelor's Degree or equivalent experience in Fraud & Abuse Investigations
• Minimum of 10 years of experience in Healthcare Fraud or data analysis
• Experience in healthcare delivery and/or payer systems
• Proficiency in SAS and SQL for analytics projects
• Preferred certifications include Certified Fraud Examiner or Accredited Healthcare Fraud Investigator