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Special Investigations Unit Investigator

7/4/2025

No location specified

Job Summary

A company is looking for a Special Investigations Unit Investigator.

Key Responsibilities
  • Investigate assigned fraud, waste, and abuse cases, including member/provider outreach and financial tracking
  • Conduct risk assessments on FWA trends and assist with the Medicaid Recipient Restriction program
  • Document investigative activities and maintain the FWA case system with accurate records
Required Qualifications
  • Bachelor's Degree preferred or 2-4 years of related experience in investigations, claims, or data analysis
  • Experience conducting investigations within a healthcare environment preferred
  • Knowledge of CPT and ICD-10 coding of procedures and diagnosis is preferred
  • Familiarity with medical terminology, human anatomy/physiology, pharmacology, and pathology is preferred
  • Proficiency in MS Office, particularly Excel and Word

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