SIU Investigator - Remote

Overview

The SIU Investigator is responsible for conducting investigations of potential fraud, waste, and abuse in the healthcare sector, ensuring compliance with laws and regulations.

In Short

• Conduct investigations of potential healthcare fraud.
• Perform claims data mining and fraud analysis.
• Prepare investigative reports for leadership and law enforcement.
• Evaluate reports of potential fraud and make recommendations.
• Ensure compliance with evidentiary requirements.
• Collaborate with internal and external stakeholders.
• Maintain effective communication throughout the investigation process.
• Adhere to departmental policies and procedures.
• Provide recommendations for process enhancements.
• Participate in continuous improvement initiatives.

Requirements

• Bachelor's degree in Criminal Justice or related field.
• 2 years of experience in investigation or audit.
• Experience in data or crime analysis preferred.
• Ability to think critically and problem solve.
• Strong communication and interpersonal skills.
• Ability to work independently with a high degree of autonomy.
• Knowledge of healthcare fraud regulations.
• Preferred certifications: Certified Fraud Examiner or similar.
• Experience with pharmacy and medical claims processing.
• Must be eligible to work in the USA without visa sponsorship.

Benefits

• Competitive salary based on experience.
• Comprehensive benefits package.
• Opportunity for career advancement.
• Supportive and collaborative work environment.
• Involvement in meaningful work that impacts lives.
• Encouragement of diverse candidates.
• Equal opportunity employer.
• Tobacco-Free Workplace.
• Flexible work arrangements.
• Access to professional development resources.