Junior Medicaid Fraud Investigator

Job Summary

Working fully remote, the full-time Junior Healthcare Fraud, Waste & Abuse (FWA) Investigator will assist the Medicaid Special Investigations Unit (SIU) in reviewing claims, medical records, and provider activities to identify potential fraud, waste, and abuse while participating in the investigative lifecycle.

Key Responsibilities

• Conduct SIU investigations involving Medicaid fraud, waste, and abuse across various healthcare entities
• Review and analyze Medicaid claims data to identify unusual billing patterns and potential FWA indicators
• Prepare clear investigative notes, case summaries, and documentation while maintaining organized investigative files

Required Qualifications

• Bachelor's degree in healthcare, criminal justice, business, finance, public health, or a related field
• 1-3 years of experience in healthcare, claims, medical billing/coding, auditing, compliance, or investigations
• Proficiency with Microsoft Office, particularly Excel and Word
• Ability to work independently in a fully remote environment while collaborating with a distributed team
• Strong analytical skills and attention to detail in evaluating large volumes of information