Job Summary

A health insurance company is seeking a Remote Fraud Investigator I.

Candidates will be responsible for the following:

• Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers
• Preparing statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review
• Preparing final case reports and notification of findings letters to providers.

Required Skills:

• Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement
• Communication skills, both oral and written required for contact with all customers
• Any combination of education and experience, which would provide an equivalent background