State Licensed SIU Investigator

Job Summary

A company is looking for a seasoned SIU Investigator with health plan experience.

Key Responsibilities

• Build and manage investigations from intake to referral to law enforcement or recovery
• Analyze claims data to identify patterns and prepare cases for regulatory scrutiny
• Collaborate with Payment Integrity, Compliance, and Legal teams effectively

Required Qualifications

• Experience working inside a payer organization
• Understanding of referrals and pre-payment vs. post-payment strategies
• Knowledge of state and federal reporting requirements
• Ability to conduct interviews with confidence and professionalism
• Proven track record of managing investigations end-to-end