Healthcare Fraud Investigator

To support the growth of a healthcare analytics firm, the full-time remote Healthcare Fraud Investigator will identify and qualify improper-payment leads, manage a live caseload, and drive cases to closure while collaborating with payer clients and internal teams. Key responsibilities Identify and qualify over 100% of budgeted leads each month, converting them from concept to accepted leads Manage an active caseload of 20 to 30 cases, ensuring a high closure rate within four to five months Maintain high standards for documentation acceptance and minimize payer complaints throughout the investigation process Required qualifications Minimum of 2 years of experience as an Investigator or Auditor in a healthcare payer or vendor environment Experience across Medicare, Medicaid, Commercial, and FEP lines of business Proficiency with auditing software and claims management systems Demonstrated ability to manage the full investigation workflow from lead generation to revenue recovery U.S.-based work authorization with no offshore candidates considered