Special Investigation Unit Investigator

Job Summary

A company is looking for a Special Investigation Unit Investigator.

Key Responsibilities

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• Perform data mining and analysis to detect aberrancies and outliers in claims

Required Qualifications

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience
• 1+ years of experience in medical claim investigation, audit, analysis, or fraud investigation
• Experience in planning and executing claims investigations or audits
• Ability to prepare detailed reports on investigative findings
• Familiarity with compliance policies and standards