Healthcare Fraud Investigator

Providing investigative support for special investigation unit activities, the full-time Healthcare Fraud Investigator will focus on the prevention, detection, and investigation of healthcare fraud, waste, and abuse, while working remotely. Key responsibilities Conducts preliminary assessments and end-to-end investigations of fraud allegations, including witness interviews and data analysis Develops leads and produces audit reports for internal and external review, ensuring compliance with regulations Coordinates with various internal departments to gather documentation pertinent to investigations and prepares referrals to regulatory agencies Required qualifications At least 2 years of investigative experience in the healthcare industry or equivalent education and experience Knowledge of managed care, Medicaid, Medicare, and claim billing codes Proven investigatory skills with the ability to analyze and determine risk objectively Understanding of data mining and analytics to detect fraud, waste, and abuse Valid and unrestricted driver's license