New York Licensed SIU Investigator

Job Summary

Investigating allegations of potential healthcare fraud and abuse, the full-time New York Licensed SIU Investigator will conduct claims investigations, document findings, and perform data analysis while working remotely.

Key responsibilities

• Conduct investigations of potential waste, abuse, and fraud in healthcare claims
• Document case activities and refer issues to appropriate parties, providing updates and recommendations
• Perform data mining and analysis to detect aberrancies and develop new queries for fraud detection

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience
• 1+ years of experience in medical claim investigation, audit, or fraud investigation
• Minimum of five years in healthcare fraud, waste, and abuse investigations or insurance claims investigation
• Experience working with law enforcement agencies or in professional investigations related to economic or insurance matters