Lead Fraud Investigator

Job Summary HCSC is looking for a dynamic individual to join its Fraud Investigations team! This position will be responsible for identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and the misuse of claims, billing, or improper payments. May also be responsible for establishing and maintaining close liaison (as indicated in plan design) with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Will be reviewing transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testifying in court. Incumbent conducts complex, large-scale investigations and mentor junior-level investigators. Expertise in data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills. NOTE: this role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days. Relocation is NOT offered; sponsorship will NOT be extended either now or in the future. Job Requirements Bachelor’s Degree. Seven (7) years’ fraud investigative experience OR 7 years of direct law enforcement experience (local, state, or federal). Experience directing complex fraud investigations which result in criminal or civil prosecutions. Aptitude with planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations. Familiarity with state and federal laws apps. Expertise in data analysis tools, investigative proficiency, and strong communication skills. Proficiency with MS Office (Word, Excel, PowerPoint) as well as Workday. Preferred Requirements Certified Professional Coder (CPC). Certified Fraud Examiner (CFE). Accredited Health Care Fraud Investigator. Exceptional ability to identify fraud, waste and abuse trends and work with advanced analytics in identifying emerging schemes and trends. Pay Transparency Statement At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location. #J-18808-Ljbffr HCSC