Healthcare Fraud Waste Abuse Investigator (Full-time, Remote)

Responsibilities • Identify and conduct investigations into known or suspected FWA with high autonomy • Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. • Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity) • Participate in the development and presentation of FWA-related education for assigned Customers • Perform coding reviews for flagged claims, to support Coding team (if applicable). • Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. • Bachelor's degree in Criminal Justice or a related field, or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity • Experience handling confidential information and following policies, rules, and regulations • Experience with commercial, Medicare, or Medicaid claims • Strong analytical and problem-solving skills, with attention to detail and accuracy • Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers • Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar is preferred • Certified Professional Coder (CPC) or similar is preferred Apply tot his job