SIU Investigator

Job Summary

Seeking a seasoned SIU Investigator with health plan experience, the full-time position focuses on building and managing cases from intake to referral, ensuring compliance with regulatory standards while collaborating with various departments.

Key responsibilities

• Conduct end-to-end investigations, including case preparation and referrals to law enforcement
• Analyze claims data to identify patterns and develop prosecutable cases
• Collaborate with Payment Integrity, Compliance, and Legal teams to ensure adherence to state and federal reporting requirements

Required qualifications

• Experience working within a health plan or payer environment
• Strong understanding of pre-payment and post-payment strategies
• Proven ability to conduct interviews professionally and confidently
• Knowledge of regulatory scrutiny and compliance standards
• Demonstrated ability to manage investigations from start to finish