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, assisting in special claims investigations or audits
• Monitor business processes for integrity and compliance in billing and claims payment
• Prepare detailed reports on investigative findings for referral to Federal and State agencies

Required Qualifications

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