Remote Senior Fraud and Waste Investigator

Location: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington

Compensation: To Be Discussed

Staff Reviewed: Wed, Nov 11, 2020

This job expires in 7 days

Job Category: Investigations

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Bachelors

Job Summary

A health insurance company is in need of a Remote Senior Fraud and Waste Investigator.

Must be able to:

  • Conduct clinical investigations of allegations of fraudulent and abusive practices
  • Coordinate investigation with law enforcement authorities and assembles evidence and documentation
  • Conduct on-site and virtual audits of provider records ensuring appropriateness of billing practices.

Applicants must meet the following qualifications:

  • Ability to travel 25% within the US
  • Bachelor's degree in Healthcare or equivalent years of experience within a similar role
  • Must hold an valid RN license
  • 2+ years of healthcare experience within a fraud investigations or auditing role
  • 1+ years with medical coding as well as solid knowledge of healthcare payment methodologies
  • Inquisitive nature with ability to analyze data to metrics