Healthcare Fraud Investigator

Job Summary

A company is looking for a Special Investigations Unit (SIU) Investigator.

Key Responsibilities

• Investigate allegations of healthcare fraud and abuse, documenting leads and referring issues as necessary
• Perform data mining and analysis to detect anomalies in claims and develop internal reports on potential fraud
• Coordinate with Health Plans and prepare detailed reports on investigative findings for regulatory agencies

Required Qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 3+ years of experience in medical claim investigation, audit, analysis, or fraud investigation
• Knowledge of Microsoft Applications, medical coding, and claims processing preferred
• Accredited Health Care Fraud Investigator or Certified Fraud Examiner preferred
• Certified Professional Coder preferred