Healthcare Fraud Investigator

Job Summary

A company is looking for an Investigator for the Special Investigative Unit (Remote).

Key Responsibilities

• Develops leads and assesses potential fraud, waste, or abuse (FWA) corroborated by evidence
• Conducts investigations including witness interviews, data analytics, and medical record reviews
• Prepares detailed reports and referrals to regulatory agencies and ensures compliance with regulations

Required Qualifications

• At least 2 years of investigative experience in the health care industry or equivalent education and experience
• Valid and unrestricted driver's license
• Knowledge of investigative procedures, managed care, and health care delivery systems
• Understanding of claim billing codes and data analytics for detecting FWA
• Ability to research and interpret regulatory requirements