Identify and investigate aberrant behavior in medical claims data and enrollment data
Manage investigative caseload from identification to resolution
Data mining, planning, analysis, sampling, and medical records requests
Audit interpretation, overpayment recovery, and reporting to regulators
Monitor providers with substantiated findings and track behavior change
Meet metrics for caseload, turnaround times, and unit goals

🎯 Requirements

3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
3+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

🎁 Benefits

Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance

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