Senior Investigator

Job Summary

A company is looking for a Senior Investigator.

Key Responsibilities

• Triaging, investigating, and resolving potential instances of healthcare fraud and abusive conduct
• Gathering and analyzing data to determine behaviors and document findings in compliance with laws and regulations
• Conducting interviews and onsite audits to collect necessary information related to investigations

Required Qualifications

• 5+ years of experience in an investigative role within healthcare claims or health insurance
• 2+ years of experience working with law enforcement or legal entities
• 1+ years of experience with behavioral health codes and service delivery
• Intermediate proficiency in MS Excel and MS Word
• Experience in conducting fraud investigations