Healthcare Fraud Investigator - Remote
About the position
The Healthcare Fraud Investigator will join the Special Investigations Unit to support the US Commercial Healthcare Business by conducting audits and investigations of potentially fraudulent claim activities by providers. The role requires complex investigative and analytical skills to develop and implement investigative processes, make recommendations for corrective actions, and prepare evidence for legal proceedings.
Responsibilities
Ā Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
,
Ā Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
,
Ā Lead on-site inspections and patient/provider interviews as necessary
,
Ā Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance
,
Ā Perform special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations
,
Ā Prepare reports to expedite tracking and reporting of investigations
Requirements
Ā 2+ years' experience in health insurance fraud investigation/audit preferred
,
Ā Associates Degree required; Bachelor's Degree in Criminal Justice or related field strongly preferred
,
Ā Experience with leading investigations, data analysis, report writing, presenting findings highly preferred
,
Ā Clear and concise verbal and written communication skills
,
Ā Strong computer skills are required - Excel, Access and Word
,
Ā Strong attention to detail, analytical & critical thinking skills
,
Ā Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) preferred
Nice-to-haves
Benefits
Ā Medical insurance
,
Ā Vision insurance
,
Ā Dental insurance
,
Ā Well-being and behavioral health programs
,
Ā 401(k) with company match
,
Ā Company paid life insurance
,
Ā Tuition reimbursement
,
Ā Minimum of 18 days of paid time off per year
,
Ā Paid holidays
Apply Now
The Healthcare Fraud Investigator will join the Special Investigations Unit to support the US Commercial Healthcare Business by conducting audits and investigations of potentially fraudulent claim activities by providers. The role requires complex investigative and analytical skills to develop and implement investigative processes, make recommendations for corrective actions, and prepare evidence for legal proceedings.
Responsibilities
Ā Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
,
Ā Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
,
Ā Lead on-site inspections and patient/provider interviews as necessary
,
Ā Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance
,
Ā Perform special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations
,
Ā Prepare reports to expedite tracking and reporting of investigations
Requirements
Ā 2+ years' experience in health insurance fraud investigation/audit preferred
,
Ā Associates Degree required; Bachelor's Degree in Criminal Justice or related field strongly preferred
,
Ā Experience with leading investigations, data analysis, report writing, presenting findings highly preferred
,
Ā Clear and concise verbal and written communication skills
,
Ā Strong computer skills are required - Excel, Access and Word
,
Ā Strong attention to detail, analytical & critical thinking skills
,
Ā Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) preferred
Nice-to-haves
Benefits
Ā Medical insurance
,
Ā Vision insurance
,
Ā Dental insurance
,
Ā Well-being and behavioral health programs
,
Ā 401(k) with company match
,
Ā Company paid life insurance
,
Ā Tuition reimbursement
,
Ā Minimum of 18 days of paid time off per year
,
Ā Paid holidays
Apply Now