Junior Healthcare Fraud Investigator – Remote/Entry Level ID-9613

Join our Special Investigations Unit as a Fraud Investigator, supporting our US Commercial Healthcare Business, responsible for conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. You will bring complex investigative and analytical skills that include planning, developing and implementing investigative processes and procedures.  You will make recommendations for potential corrective actions that include prosecution, recovery and/or litigation based on investigative findings.

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Key Responsibilities:

  • Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
  • Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
  • Leads on-site inspections and patient/provider interviews as necessary
  • Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance. May represent company as a witness in judicial proceedings when appropriate
  • Performs special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations
  • Prepare reports to expedite tracking and reporting of investigations

Requirements:

  • 2+ years’ experience in health insurance fraud investigation/audit preferred
  • Associates Degree required; Bachelor’s Degree in Criminal Justice or related field strongly preferred
  • Experience with ​leading investigations, data analysis, report writing, presenting findings highly preferred
  • Clear and concise verbal and written communication skills
  • Strong computer skills are required – Excel, Access and Word
  • Strong attention to detail, analytical & critical thinking skills
  • Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) preferred

Junior Healthcare Fraud Investigator – Remote/Entry Level ID-9613

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