Identify and investigate aberrant behavior in medical claims and enrollment data
Manage an investigative caseload from start to resolution
Data mining, analysis, and sampling; investigation planning
Medical records requests, audit interpretation, overpayment recovery
Report to regulatory agencies and monitor provider behavior
Meet caseload and turnaround metrics for the SIU team

🎯 Requirements

3+ years healthcare fraud investigation or professional investigation experience
3+ years experience with fraud statutes and federal recoupment guidelines
Bachelor's degree in Criminal Justice or related field (bonus)
HIPAA, data privacy, and data security processes
Certifications such as CFE, AHFI, or CAFP (or similar)
CPC or similar certification (bonus)

🎁 Benefits

Medical, dental, and vision benefits
Unlimited vacation program
Annual performance bonuses
401(k) plan participation
11 paid holidays and paid sick time
Life and disability insurance

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