SIU Investigator - Medical Provider and Premium Fraud - Remote

Overview

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.

In Short

• Seeking a detail-oriented SIU Investigator specializing in medical provider and premium fraud.
• Investigate suspicious claims and uncover fraudulent activities.
• Collaborate with law enforcement and legal departments.
• Conduct thorough investigations into medical provider fraud.
• Analyze claims and healthcare service data for fraud indicators.
• Prepare detailed investigative reports and communicate findings.
• Oversee investigations assigned to investigative vendors.
• Ensure compliance with legal and regulatory standards.
• Stay updated on industry trends and emerging fraud schemes.
• Up to 5% travel may be required.

Requirements

• 5 years of experience in SIU investigations for Workers Compensation and Commercial Auto Claims.
• Bachelor's Degree in a related field preferred.
• Demonstrated vendor oversight expertise.
• Excellent written and verbal communication skills.
• Working knowledge of medical coding; CPT, HCPCS preferred.
• Proficient in insurance fraud investigations.
• Proficiency with Google Suite and Microsoft Office.
• Strong organizational skills.
• Desire for continued professional development.
• Customer service oriented.

Benefits

• Competitive cash compensation.
• Equity options.
• Comprehensive health plans.
• Generous PTO.
• 401k match.
• Generous parental and caregiver leave.
• Core values reflected in work culture.