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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