Fraud Investigator
Virtual Vocations Inc
Conducting comprehensive fraud, waste, and abuse (FWA) investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with internal and external stakeholders to support case resolution and ensure compliance with regulations in a remote work environment. Key responsibilities Conducts FWA investigations using various data sources to identify misconduct and support case resolution Prepares investigative reports and collaborates with internal and external partners to coordinate investigative activities Monitors for emerging fraud schemes and recommends actions for further review Required qualifications Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience 2+ years of experience in fraud investigations, healthcare investigations, claims audits, or related fields Experience analyzing healthcare claims, medical records, and billing documentation preferred Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or similar certification preferred
Vacancy posted 5 days ago
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