Investigation Quality Audit Analyst

Job Summary

A company is looking for an Investigation Quality Audit Analyst to ensure the integrity, quality, and compliance of healthcare investigations through audits and collaboration.

Key Responsibilities

• Conduct regular audits of investigative case documentation to ensure compliance with internal policies and industry standards
• Identify trends and discrepancies, providing actionable insights to leadership
• Develop and maintain audit tools and tracking systems for consistent reviews

Required Qualifications, Training, and Education

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 3+ years of experience in medical claim investigation, audit, or healthcare fraud investigation, or 2+ years with a relevant certification
• Relevant certifications preferred: CFE, AHFI, CIA, CHC, CPC, or CPMA
• Experience in developing training materials based on audit findings
• Familiarity with compliance and quality standards in healthcare investigations