Pennsylvania Licensed SIU Investigator

Job Summary

A company is looking for a SIU Investigator - Remote.

Key Responsibilities

• Investigate assigned dental fraud, waste, and abuse cases, including member/provider outreach and financial tracking
• Plan and execute dental investigations or audits through document review, interviews, and data analysis
• Conduct detailed research on regulatory requirements and maintain accurate documentation of investigative activities

Required Qualifications

• Bachelor's Degree preferred or 2-4 years of related experience in investigations, claims, medical coding, auditing, compliance, or data analysis
• Experience conducting investigations within a healthcare environment preferred
• Knowledge of CPT and ICD-10 coding preferred
• Knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology preferred
• Act 34 clearance required