State Licensed Fraud Investigator

Job Summary

A company is looking for a Special Investigation Unit Investigator to investigate allegations of potential healthcare fraud and abuse activity.

Key Responsibilities

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• Perform data mining and analysis to detect aberrancies and outliers in claims

Required Qualifications, Training, and Education

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
• 1+ years of experience in medical claim investigation, audit, analysis, or fraud investigation required
• Specific experience requirements vary by state, including a minimum of 2 to 5 years in relevant fields
• Experience in healthcare fraud, waste, and abuse investigations may be required depending on the state
• Additional qualifications may include degrees or relevant experience in criminal justice or related fields