Fraud Investigation Senior Analyst

Assisting in the detection and investigation of fraud, waste, and abuse, the full-time salaried Fraud Investigation Senior Analyst will review claims data, conduct investigations, and collaborate with regulatory agencies while working remotely. Key responsibilities Leverage analytical skills to review claims data and identify patterns of suspected fraud, waste, and abuse Assist in the triage and preliminary investigation of internal and external fraud complaints, ensuring compliance with documentation standards Participate in prepayment reviews and produce detailed investigative reports based on findings Required qualifications 3-5 years of work experience in a relevant field CPC or equivalent coding certification Working knowledge of standard industry coding guidelines such as CPT, HCPCs, and ICD-10 Experience reviewing medical records to ensure documentation matches services billed Experience interpreting detailed claims data