Healthcare Fraud Investigator

Job Summary

Seeking a full-time remote Healthcare Fraud Investigator, the successful candidate will manage complex investigations into healthcare fraud, waste, and abuse, utilizing data analysis techniques and serving as a subject matter expert while collaborating with various stakeholders.

Key responsibilities

• Lead complex investigations into allegations of healthcare fraud, waste, and abuse
• Utilize advanced data mining and analysis techniques to identify anomalies in healthcare transactions
• Provide expert guidance and training to other SIU Investigators and contribute to policy development

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• Minimum of 3 years of experience in health insurance fraud investigation
• At least 5 years of experience as a detective or investigator for a law enforcement agency
• Proven experience with Medicare and/or Medicaid programs, including medical claim billing
• Demonstrated experience with data analysis techniques and AI tools