PA Licensed RN Fraud Investigator

Job Summary

A company is looking for a RN Fraud Investigator.

Key Responsibilities

• Identify discrepancies in paid claims and analyze patterns for potential fraud
• Review and evaluate cases for compliance with regulations and medical necessity
• Prepare case findings and coordinate with legal counsel for hearings and sanctions

Required Qualifications

• RN License in Pennsylvania
• Experience in claims analysis and fraud detection
• Knowledge of State and Federal healthcare regulations
• Proficiency in using Word and Excel for report preparation
• Ability to participate in teleconferences and meetings as needed