Bilingual Junior Healthcare Fraud Investigator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Evaluate information obtained through investigation or audit, documenting findings and crafting written summaries and recommendations.

• Create evidence packages for referral to external parties, including contract holders, state insurance fraud bureaus, and law enforcement agencies.

• Assist with on-site inspections and conduct patient/provider interviews as required.

• Address subpoenas and fulfill information requests from law enforcement agencies and State Departments of Insurance.

• May act as a company representative in judicial proceedings when necessary.

• Generate reports to facilitate the tracking and reporting of investigations.

⛳️ Requirements

• Residing in the South Florida area (Miami, Homestead) and West Palm Beach to accommodate site visits.

• Bilingual in Spanish.

• Bachelor’s degree in Criminal Justice or a related discipline.

• A minimum of 1 year of professional experience, ideally in health insurance investigations or audits.

• Exceptional technical and analytical skills, particularly proficient in Access, Excel, and Word.

• Strong verbal and written communication abilities, paired with effective conflict management skills.

• Sharp capacity to navigate ambiguity and apply reasoning skills.

• Demonstrated desire and capability to lead.

🏝️ Benefits

• Health insurance.

• Flexible work arrangements.

• Opportunities for professional development.

• Paid time off.