Investigator, Special Investigative Unit

Job Summary

A company is looking for an Investigator for its Special Investigative Unit (Remote).

Key Responsibilities

• Develops leads and assesses evidence related to potential fraud, waste, or abuse (FWA)
• Conducts investigations, including interviews, data analytics, and medical record reviews
• Documents case information accurately and prepares referrals to regulatory agencies when FWA is identified

Required Qualifications

• At least 2 years of investigative experience in the health care industry or equivalent education and experience
• Valid and unrestricted driver's license
• Knowledge of managed care, Medicaid, Medicare, and Marketplace programs
• Understanding of claim billing codes, medical terminology, and health care delivery systems
• Experience with data analytics to detect FWA