Investigator for Fraud Compliance

Job Summary

Conducting fraud, waste, and abuse investigations, the full-time Investigator for Fraud Compliance will review claims data, medical records, and provider information, while documenting investigative activities and collaborating with stakeholders in a remote setting.

Key responsibilities:

• Conduct fraud, waste, and abuse investigations using various data sources to identify potential misconduct
• Document and analyze investigative findings and maintain compliance with regulatory requirements
• Prepare reports and collaborate with internal and external partners to support case resolution efforts

Required qualifications:

• Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field, or equivalent experience
• 2+ years of experience in fraud, waste, and abuse investigations or related investigative fields
• Experience analyzing healthcare claims, medical records, and billing documentation preferred
• Relevant certifications such as Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) preferred