SIU Investigator

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

📋 Description

• Investigate claims of suspected healthcare fraud and abuse activities.

• Support the planning, organization, and execution of investigations or audits to identify, assess, and quantify potential healthcare fraud and abuse.

• Carry out inquiries into possible waste, abuse, and fraud.

• Record activities for each case and escalate issues to the relevant parties.

• Conduct data mining and analysis to identify anomalies and outliers within claims.

• Create new queries and reports aimed at uncovering potential waste, abuse, and fraud.

• Provide updates on investigation progress and collaborate with Health Plans on recommendations, further actions, and resolutions.

• Assist with intricate allegations of healthcare fraud.

• Prepare summary or detailed reports of investigative findings for submission to Federal and State agencies.

• Undertake various special projects and audits.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or 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 opportunities.

• Paid time off in addition to holidays.

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