Senior SIU Investigator

Job Summary

A company is looking for a Senior SIU Investigator to investigate allegations of healthcare fraud and abuse activity.

Key Responsibilities

• Investigate waste, abuse, and fraud leads, documenting and referring issues as necessary
• Perform data mining and analysis to detect anomalies in claims
• Prepare detailed reports on investigative findings for referral to regulatory agencies

Required Qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 3+ years of experience in medical claim investigation, audit, analysis, or fraud investigation
• Knowledge of Microsoft Applications, medical coding, and claims processing preferred
• Ability to coordinate with various stakeholders on investigations
• Willingness to travel occasionally to support the PA health plan