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 in a remote work environment.

Key responsibilities

• Conducts thorough investigations involving providers, members, and vendors using various data sources and analytical methods
• Prepares comprehensive reports and documentation for leadership, regulatory agencies, and law enforcement
• Collaborates with stakeholders to support investigative activities and recommend enhancements to processes and monitoring activities

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 fraud, waste, and abuse investigations or related investigative work
• Experience leading complex investigations and preparing detailed reports for various stakeholders
• Knowledge of federal and state healthcare regulations, including Medicaid and Medicare
• Preferred certifications include Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)