Healthcare Fraud Investigator

Job Summary

Providing investigative support for special investigation unit activities, the full-time Healthcare Fraud Investigator will focus on the prevention, detection, investigation, and reporting of healthcare fraud, waste, and abuse while working remotely.

Key responsibilities

• Develop leads and assess potential fraud, waste, or abuse corroborated by evidence
• Conduct end-to-end investigations, including witness interviews, data analytics, and medical record reviews
• Prepare detailed investigation referrals to regulatory agencies and ensure compliance with applicable regulations

Required qualifications

• At least 2 years of investigative experience in the healthcare industry or equivalent education and experience
• Proven investigatory skills with knowledge of fraud investigation procedures
• Understanding of claim billing codes, medical terminology, and healthcare delivery systems
• Ability to research and interpret regulatory requirements
• Experience with data analytics to detect fraud, waste, and abuse