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, and investigation of healthcare fraud, waste, and abuse, while working remotely.

Key responsibilities

• Conducts preliminary assessments and end-to-end investigations of fraud allegations, including witness interviews and data analysis
• Develops leads and produces audit reports for internal and external review, ensuring compliance with regulations
• Coordinates with various internal departments to gather documentation pertinent to investigations and prepares referrals to regulatory agencies

Required qualifications

• At least 2 years of investigative experience in the healthcare industry or equivalent education and experience
• Knowledge of managed care, Medicaid, Medicare, and claim billing codes
• Proven investigatory skills with the ability to analyze and determine risk objectively
• Understanding of data mining and analytics to detect fraud, waste, and abuse
• Valid and unrestricted driver's license