Senior Fraud Investigator

Independently leading complex fraud, waste, and abuse investigations, the full-time Senior Fraud Investigator will utilize advanced investigative techniques and data analysis to identify misconduct and support corrective actions in a remote work environment. Key responsibilities Conducts thorough investigations involving providers, members, and vendors using various data sources and analytical methods Prepares comprehensive reports and documentation for leadership, regulatory agencies, and law enforcement Collaborates with stakeholders to support investigative activities and recommend enhancements to processes and monitoring activities Required qualifications Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; Master's Degree preferred 4+ years of experience in fraud, waste, and abuse investigations or related investigative work Experience leading complex investigations and preparing detailed reports for various stakeholders Knowledge of federal and state healthcare regulations, including Medicaid and Medicare Preferred certifications include Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)