Investigator for Fraud Compliance

Conducting fraud, waste, and abuse investigations, the full-time Investigator for Fraud Compliance will review claims data, medical records, and provider information, while documenting investigative activities and collaborating with stakeholders in a remote setting.

Key responsibilities:

Conduct fraud, waste, and abuse investigations using various data sources to identify potential misconduct Document and analyze investigative findings and maintain compliance with regulatory requirements Prepare reports and collaborate with internal and external partners to support case resolution efforts Required qualifications: Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field, or equivalent experience 2+ years of experience in fraud, waste, and abuse investigations or related investigative fields Experience analyzing healthcare claims, medical records, and billing documentation preferred Relevant certifications such as Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) preferred