Remote Investigator

Job Summary

A company is looking for an Investigator (Remote).

Key Responsibilities

• Conduct low to medium level investigations of suspected fraud, waste, and abuse, developing and executing investigative plans
• Research and analyze claims data to proactively identify potential fraud cases, maintaining organized and detailed case file documentation
• Initiate claim adjustments and recover funds while performing special projects as assigned by management

Required Qualifications

• Bachelor's Degree or 4 years of relevant work experience in lieu of a degree
• 2 years of experience in insurance, investigative, health care, nursing, or law enforcement
• Preferred certifications include Certified Fraud Examiner (CFE) or Certified Insurance Fraud Investigator (CIFI)
• Knowledge of medical terminology, ICD 10, and CPT Codes is preferred
• Experience in health care industry and claims/customer service methods is preferred