Special Investigations Unit Investigator

Job Summary

A company is looking for a Special Investigations Unit Investigator.

Key Responsibilities

• Investigate assigned fraud, waste, and abuse cases, including member/provider outreach and financial tracking
• Conduct risk assessments on FWA trends and assist with the Medicaid Recipient Restriction program
• Document investigative activities and maintain the FWA case system with accurate records

Required Qualifications

• Bachelor's Degree preferred or 2-4 years of related experience in investigations, claims, or data analysis
• Experience conducting investigations within a healthcare environment preferred
• Knowledge of CPT and ICD-10 coding of procedures and diagnosis is preferred
• Familiarity with medical terminology, human anatomy/physiology, pharmacology, and pathology is preferred
• Proficiency in MS Office, particularly Excel and Word