Lead Fraud Investigator

Job Summary At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. This position will be responsible for identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and misuse of claims, billing, or improper payments. May also be responsible for establishing and maintaining close liaison with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Will review transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testify in court. The incumbent conducts complex, large-scale investigations and mentors junior-level investigators. Employs expertise in data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills. Note: this role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days. Relocation is NOT offered; sponsorship will NOT be extended either now or in the future. Responsibilities Identify, develop and manage complex high‑impact healthcare fraud investigations resulting in criminal and/or civil prosecution and misuse of claims, billing, or improper payments. Establish and maintain close liaison with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Review transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testify in court. Conduct complex, large‑scale investigations and mentor junior‑level investigators. Utilize data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills. Qualifications Bachelor’s Degree. Seven (7) years’ fraud investigative experience OR 7 years of direct law enforcement experience (local, state, or federal). Experience directing complex fraud investigations which result in criminal or civil prosecutions. Aptitude with planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations. Familiarity with state and federal laws apps. Expertise in data analysis tools, investigative proficiency, and strong communication skills. Proficiency with MS Office (Word, Excel, PowerPoint) as well as Workday. Preferred Qualifications Certified Professional Coder (CPC). Certified Fraud Examiner (CFE). Accredited Health Care Fraud Investigator. Exceptional ability to identify fraud, waste and abuse trends and work with advanced analytics in identifying emerging schemes and trends. Pay and Benefits Base Pay Range $61,500.00 - $136,100.00. Exact compensation may vary based on skills, experience, and location. The compensation offered will vary depending on your job‑related skills, education, knowledge, and experience. Pay Transparency Statement: You will be part of an organization committed to offering meaningful benefits to employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. EEO Statement HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. #J-18808-Ljbffr Health Care Service Corp.