New Jersey Licensed Investigator III

Job Summary

A company is looking for an Investigator III to lead investigations within the Special Investigation Unit.

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 legal action

Required Qualifications, Training, and Education

• 7+ years of professional investigation experience in economic or insurance-related matters
• AHFI, CFE, and CPC certifications are required; medical field licensing is a plus
• In-depth knowledge of health insurance operations, including claims and enrollment
• Working knowledge of NJ criminal and civil law related to health insurance fraud
• Experience with investigative processes is required