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