SIU Investigator

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

📋 Description

• Conduct inquiries into allegations of possible healthcare fraud and abuse activities.

• Support the planning, organization, and execution of claims investigations or audits aimed at identifying, assessing, and measuring potential healthcare fraud and abuse.

• Carry out investigations into potential waste, abuse, and fraud.

• Record activities for each case and refer concerns to the appropriate parties.

• Execute data mining and analysis to identify anomalies and outliers in claims.

• Create new queries and reports to uncover potential waste, abuse, and fraud.

• Provide updates on case progress for investigations and collaborate with Health Plans on recommendations and subsequent actions or resolutions.

• Assist with intricate allegations of healthcare fraud.

• Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies.

• Complete various special projects and audits.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in Business, Criminal Justice, Healthcare, a related field, or equivalent experience is required.

• A minimum of 1 year of experience in medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation is required.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office work schedules.