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 Requirements 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 The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future. We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave. Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law. This job is not eligible for bonuses, incentives or commissions. Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status. By clicking “Apply Today” you agree to receive calls, AI-generated calls, text messages or emails from Kforce and its affiliates, and service providers. Note that if you choose to communicate with Kforce via text messaging the frequency may vary, and message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You will always have the right to cease communicating via text by using key words such as STOP. #J-18808-Ljbffr