Pharmacy Fraud Investigative Analyst

Job Summary

A company is looking for an FWA Investigative Analyst-Pharmacy.

Key Responsibilities

• Investigate cases of potential pharmacy fraud, waste, or abuse using analytical tools and external referrals
• Collect and evaluate suspicious patterns in claims data and develop investigative strategies
• Manage case reviews and coordinate with other departments to mitigate fraud, waste, and abuse

Required Qualifications

• 2-5 years' experience in investigations related to pharmacy/healthcare fraud, waste, and abuse
• Bachelor's degree from a 4-year college or university or equivalent training and experience
• Strong analytical reasoning skills and knowledge of the pharmaceutical industry and claim data
• Experience with medical and pharmacy claim processing and knowledge of MS Excel and Word
• Willingness to learn proprietary software and systems