Healthcare Fraud Investigator

Job Summary

A company is looking for Investigators specializing in Healthcare Fraud, Waste & Abuse.

Key Responsibilities

• Conduct complex investigations into potential fraud, waste, and abuse for health plans and government programs
• Review claims data, medical records, and provider patterns to identify anomalies
• Prepare investigative reports for audits, hearings, and legal proceedings

Required Qualifications

• Experience in healthcare investigations, SIU operations, or a related compliance role
• Knowledge of claims data, CPT/HCPCS codes, and medical billing practices
• Strong investigative, analytical, and report-writing skills
• Commitment to integrity, accuracy, and ethical standards