Healthcare Fraud Investigator

Job Summary

To support the growth of a healthcare analytics firm, the full-time remote Healthcare Fraud Investigator will identify and qualify improper-payment leads, manage a live caseload, and drive cases to closure while collaborating with payer clients and internal teams.

Key responsibilities

• Identify and qualify over 100% of budgeted leads each month, converting them from concept to accepted leads
• Manage an active caseload of 20 to 30 cases, ensuring a high closure rate within four to five months
• Maintain high standards for documentation acceptance and minimize payer complaints throughout the investigation process

Required qualifications

• Minimum of 2 years of experience as an Investigator or Auditor in a healthcare payer or vendor environment
• Experience across Medicare, Medicaid, Commercial, and FEP lines of business
• Proficiency with auditing software and claims management systems
• Demonstrated ability to manage the full investigation workflow from lead generation to revenue recovery
• U.S.-based work authorization with no offshore candidates considered