Senior Investigator, Special Investigations

Job Summary

A company is looking for a Senior Investigator, Special Investigations.

Key Responsibilities

• Conduct data mining and analysis to identify fraud, waste, and abuse in healthcare transactions
• Lead complex investigations and serve as a subject matter expert while mentoring SIU staff
• Create and present reports on findings and collaborate with stakeholders to resolve detected issues

Required Qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• Minimum of 3 years of experience in health insurance fraud investigation
• Experience with Medicare and/or Medicaid programs, including medical claim billing and provider contracting
• Demonstrated experience with internal employee investigations and data analysis techniques
• Certifications such as Certified Fraud Examiner (CFE) and/or Certified Professional Coder (CPC) are preferred