Job Details

A company is looking for an Investigator for its Special Investigative Unit (Remote).Key ResponsibilitiesDevelops leads and assesses evidence related to potential fraud, waste, or abuse (FWA)Conducts investigations, including interviews, data analytics, and medical record reviewsDocuments case information accurately and prepares referrals to regulatory agencies when FWA is identifiedRequired QualificationsAt least 2 years of investigative experience in the health care industry or equivalent education and experienceValid and unrestricted driver's licenseKnowledge of managed care, Medicaid, Medicare, and Marketplace programsUnderstanding of claim billing codes, medical terminology, and health care delivery systemsExperience with data analytics to detect FWA