Full Time Investigator
Virtual Vocations Inc
Seeking a seasoned SIU Investigator with health plan experience, the full-time position focuses on building and managing cases from intake to referral, ensuring compliance with regulatory standards while collaborating with various departments.
Key responsibilities
Conduct end-to-end investigations, including case preparation and referrals to law enforcement
Analyze claims data to identify patterns and develop prosecutable cases
Collaborate with Payment Integrity, Compliance, and Legal teams to ensure adherence to state and federal reporting requirements
Required qualifications
Experience working within a health plan or payer environment
Strong understanding of pre-payment and post-payment strategies
Proven ability to conduct interviews professionally and confidently
Knowledge of regulatory scrutiny and compliance standards
Demonstrated ability to manage investigations from start to finish
Vacancy posted 4 days ago
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