Healthcare Fraud Investigator

Job Summary

Investigating allegations of potential healthcare fraud and abuse, the full-time SIU Investigator will conduct claims investigations, perform data analysis, and prepare detailed reports while working remotely from various locations.

Key responsibilities

• Conduct investigations of potential waste, abuse, and fraud in healthcare claims
• Document case activities and refer issues to appropriate parties for resolution
• Perform data mining and analysis to identify aberrancies and develop reports on findings

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 1+ years of experience in medical claim investigation, audit, analysis, or fraud investigation
• Strong Excel skills preferred
• Certified Fraud Examiner (CFE) certification preferred