Senior Fraud Investigator

Job Summary

Independently leading complex fraud, waste, and abuse investigations, the full-time Senior Fraud Investigator will utilize advanced investigative techniques and data analysis to identify misconduct and support corrective actions while working remotely.

Key responsibilities

• Lead investigations into fraud, waste, and abuse involving various entities using data analysis and investigative resources
• Analyze claims, billing patterns, and medical records to identify potential fraud and compliance concerns
• Prepare comprehensive reports and collaborate with stakeholders to support investigative activities and case resolution

Required qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; Master's Degree preferred
• 4+ years of experience in conducting fraud investigations or related investigative work
• Experience leading complex investigations and preparing reports for leadership and regulatory agencies
• Knowledge of federal and state healthcare regulations, including Medicaid and Medicare, preferred
• Relevant certifications such as AHFI, CFE, CPC, or CPMA preferred