Fraud Investigation Specialist
Virtual Vocations Inc
Conducting thorough fraud, waste, and abuse (FWA) investigations, the full-time Special Investigation Unit Investigator will review claims data, medical records, and provider information while collaborating with stakeholders to ensure compliance and support case resolution in a remote setting. Key responsibilities Conducts FWA investigations using various data sources to identify potential misconduct Prepares investigative reports and collaborates with internal and external partners to support case resolution Monitors emerging fraud schemes and recommends actions for further review Required qualifications Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or related field, or equivalent experience Minimum of five years in the healthcare field focusing on fraud investigations or insurance claims Experience analyzing healthcare claims, medical records, and related documentation Preferred certifications include Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Experience with audits and compliance standards in healthcare settings is preferred
Vacancy posted 12 hours ago
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