SIU Post Pay Investigator

Job Summary

A company is looking for a SIU Post Pay Investigator.

Key Responsibilities:

• Gather and analyze data to determine behavior and understand provider/scheme at issue
• Collaborate with external sources to identify patterns and schemes related to Fraud, Waste, Abuse, and Error (FWAE)
• Conduct confidential investigations, document findings, and communicate outcomes to stakeholders

Required Qualifications:

• Associate's Degree in Criminal Justice OR residence in the state of New York or New Jersey AND 5+ years of experience in FWA/SIU or Fraud investigations
• 2+ years of experience in health insurance claims industry
• 2+ years of experience working with law enforcement or legal entities OR 3+ years of investigative experience with fraud investigations
• 1+ years of knowledge and/or experience with behavioral health codes and service delivery
• Intermediate level proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)