Program Integrity Coordinator

Job Summary

Monitoring and maintaining fraud reporting mechanisms, the full-time remote Program Integrity Investigative Coordinator I will accurately load FWA referrals, analyze allegations, and conduct interviews to support compliance with regulatory requirements.

Key responsibilities:

• Accurately load Fraud, Waste & Abuse (FWA) referrals into the SIU Case Management System
• Analyze FWA allegations to determine case closure or escalation and conduct interviews for information gathering
• Generate reports and perform data analysis to assess financial exposure related to FWA allegations

Required qualifications:

• High School Diploma or GED required; Associate's Degree in a health-related field preferred
• Minimum of three years' experience in a healthcare-related field or customer service required
• Health care experience in medical/dental claims, auditing, or medical office preferred
• Intermediate computer skills, including proficiency in Microsoft Excel, Access, Outlook, and Word
• Ability to navigate multiple software systems effectively