Senior Investigator

Job Summary

A company is looking for a Senior Investigator to conduct analyses of healthcare claims and records.

Key Responsibilities

• Conduct audits and analyze data trends to identify fraud, waste, and abuse in healthcare claims
• Generate reports and verify compliance with regulatory standards
• Collaborate with internal teams and external stakeholders to ensure the integrity of audit processes

Required Qualifications

• Proficiency in auditing, reviewing claims, and medical necessity review
• Experience with analytics and analyzing large healthcare data sets
• Strong expertise in healthcare policies, coding, and documentation review
• Bachelor's degree in healthcare, business, or related fields with relevant certifications preferred
• Familiarity with HIPAA compliance and secure file handling