Special Investigation Unit (SIU) Investigator - Remote

Overview

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse.

In Short

• Responsible for developing leads to assess potential fraud, waste, or abuse.
• Conducts preliminary assessments and full investigations including interviews and data analytics.
• Completes investigations within mandated timeframes.
• Conducts on-site and desktop investigations.
• Coordinates with internal departments for documentation.
• Detects potential fraud through billing pattern analysis.
• Prepares FWA referrals to regulatory agencies.
• Documents case information accurately.
• Provides provider education on coding practices.
• Interacts with law enforcement regarding investigations.

Requirements

• Bachelor's or Associate’s Degree in criminal justice or equivalent.
• 1-3 years of experience in investigations.
• Knowledge of fraud investigation procedures.
• Understanding of claim billing codes and health care systems.
• Proficiency in data analytics.
• Effective communication and interpersonal skills.
• Advanced skills in Microsoft Office.
• Strong analytical and problem-solving skills.
• Detail-oriented and self-motivated.
• Ability to meet tight deadlines.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer (EOE).