SIU Investigator

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

📋 Description

• Investigate claims of potential healthcare fraud and abuse activities.

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

• Conduct investigations into potential waste, abuse, and fraud.

• Document the activities related to each case and refer issues to the appropriate parties.

• Perform data mining and analysis to identify aberrancies and outliers in claims.

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

• Provide updates on the progress of investigations and coordinate with Health Plans regarding recommendations, further actions, and/or resolutions.

• Assist with complex 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, ensuring compliance with all policies and standards.

⛳️ Requirements

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

• At least 5 years of experience in the healthcare sector focusing on fraud, waste, and abuse investigations and audits.

• A minimum of 5 years of insurance claims investigation experience or professional investigative experience with law enforcement agencies.

• Over 7 years of professional investigation experience related to economic or insurance matters.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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