Auditor/Investigator I

About the role

This organization is a not-for-profit corporation partnering with public and private sectors to deliver high quality, safe, and efficient health care and human services programs. It operates multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for services supporting individuals with developmental disabilities. The organization is recognized nationally for combating fraud, waste, and abuse in large organizations and also supports underserved communities through its grant-providing foundation. The Auditor/Investigator I is an entry-level professional role focused on ensuring the integrity and accuracy of claims processes. This position involves conducting audits and investigations into claims, analyzing data, and identifying potential fraud, waste, or discrepancies. The role supports management by providing accurate recommendations and detailed documentation to facilitate claim resolution and compliance with regulations.

Responsibilities

• Conduct routine and impartial audits and investigations of customer claims
• Address customer inquiries and escalate issues as necessary
• Compile detailed records of audit findings ensuring legal and regulatory compliance
• Develop strategies to identify and prevent fraudulent activities
• Conduct interviews with witnesses, claimants, and stakeholders to gather information
• Communicate with internal teams to ensure proper audit processing
• Maintain timely and accurate documentation of all audit and investigative records
• Clearly communicate findings to customers and stakeholders
• Support management in audit proceedings ensuring compliance with relevant standards and regulations

Requirements

• Minimum Bachelor's Degree
• 0 to 2 years of experience required; 2 to 4 years preferred
• Medicaid experience preferred
• Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator certification preferred