Senior Fraud Investigator
Job Summary
Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns of fraud, prepare detailed reports, and collaborate with clients and internal teams while mentoring junior staff.
Key responsibilities
- Analyze large data sets to detect potential fraud, waste, and abuse in healthcare billing and claims
- Prepare detailed reports and develop citation guidebooks to support consistent and defensible findings
- Collaborate with clients and internal audit teams, contributing to case-building efforts and legal proceedings
Required qualifications
- Strong background in fraud prevention and investigations, preferably in healthcare or insurance
- Advanced analytical skills and experience with data analytics tools and statistical sampling methods
- Knowledge of finance and reimbursement processes, including billing and overpayment recovery
- Bachelor's degree in criminal justice, finance, healthcare administration, or a related field; advanced degrees or certifications are a plus
- Familiarity with HIPAA, OIG guidelines, and healthcare compliance frameworks
Complete Job Description
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