New Jersey Licensed Investigator II

Job Summary

A company is looking for an Investigator II to conduct analytical and investigative activities related to fraud detection and resolution.

Key Responsibilities

• Detects fraudulent activities by various parties including subscribers and providers
• Decides on the most effective investigation methods for individual cases
• Prepares and documents fraud cases, including evidence assembly for potential prosecution

Required Qualifications, Training, and Education

• Bachelor's Degree required
• Minimum of 2 years of claims, customer service, or relevant law enforcement experience required
• AHFI, CFE, or CPC certifications preferred
• In-depth knowledge of health insurance operations required
• Working knowledge of NJ Criminal and Civil Law relative to health insurance fraud preferred