SIU Investigator
$42 per hourTemporary
Kforce has a client in the Healthcare industry in Los Angeles who is looking for a SIU Investigator. Responsibilities:
- Reviews allegations and complex issues related to potential healthcare fraud, waste, and abuse involving providers, pharmacies, employers, and members
- Analyzes claims data, provider information, and other available records to identify unusual billing patterns, trends, and potential areas of concern
- Conducts research and gathers relevant information from a variety of internal and external sources, including fraud tips, referrals, public records, industry publications, and media reports
- Documents investigative activities, findings, interviews, and supporting evidence in detailed written reports and summaries
- Reviews information contained within claims processing systems, provider files, and related databases to identify billing anomalies and potential compliance concerns
- Participates in onsite reviews, audits, and information-gathering activities as assigned
- Maintains documentation and case files in accordance with organizational policies, confidentiality requirements, and regulatory guidelines
- Prepares reports and supporting documentation for internal stakeholders and designated regulatory or compliance teams as appropriate
- Responds to requests for information and assists with ongoing case tracking and documentation
- Participates in industry meetings, professional development activities, and training programs to stay informed of emerging fraud trends and investigative techniques
- Develops and maintains effective working relationships with internal departments, regulatory agencies, and other external stakeholders
- Applies subject matter expertise to support business operations, process improvement efforts, and investigative reviews
- Identifies opportunities to enhance workflows, reporting, and analytical processes
- Provides guidance, knowledge sharing, and training support to team members as needed
- To be considered for this position, candidates must have experience in a similar role, or they must possess significant knowledge, experience, and abilities to successfully perform the responsibilities listed
- Relevant education and/or training will be considered a plus
Vacancy posted 6 days ago
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