Healthcare Investigator

Performing detailed reviews of healthcare claims and medical records, the full-time remote Healthcare Investigator will identify potential fraud, waste, and compliance issues while collaborating with internal teams to prepare comprehensive reports and support corrective actions. Key responsibilities Conduct thorough investigations of healthcare claims, medical records, and billing data to detect fraud and compliance issues Analyze patterns and anomalies in data, applying relevant regulations and citation guidebooks to support findings Collaborate with internal audit, legal, and client teams to document investigative steps and prepare clear reports Required qualifications Experience reviewing medical records, claims, and billing data for accuracy and compliance Knowledge of healthcare regulations, including HIPAA, OIG guidance, and payer policies Familiarity with audit processes, including report generation and quality assurance review Data analysis skills with experience in identifying patterns and using relevant tools or software Relevant education or certification in healthcare administration, health information management, or a related field