Investigator Assistant
Schedule
Hybrid 1 – This role requires associates to be in-office 1–2 days per week, fostering collaboration and connectivity while providing flexibility to support productivity and work‑life balance. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless accommodation is granted as required by law.
Work Shift: Monday – Friday, 7:00 am to 5:00 pm (flexible start and end times for a daily 8‑hour shift).
Responsibilities
- Collects, researches, and validates bills and claims data against relevant guidelines.
- Assists in preparation of statistical and financial analysis reports.
- Responds to state and law enforcement requests for information.
- Requests medical records and additional documentation required for investigation.
- Completes initial file set‑up and tracks cases.
- Works with vendors in providing case status and updates.
- Processes and tracks all incoming reimbursement checks.
- Assists in managing fraud hotline calls.
- Provides administrative support for investigative management and staff.
Requirements
High school diploma or equivalent and a minimum of 1 year experience in healthcare, retail pharmacy, and/or Medicaid; or any combination of education and experience that provides an equivalent background.
Qualifications
- One year or more of MS Excel experience working with large data files and other general reporting tools (preferred).
- Experience in health insurance or law enforcement (highly preferred).
- Pharmacy technician license and/or pharmacy experience (preferred).
- Formulary, clinical rules, pharmacy claims analysis, and/or prior authorization experience for a pharmacy benefit manager or health plan (strongly preferred).
- Ability to communicate information clearly and concisely, both orally and in writing, in a professional and legal environment (strongly preferred).
Pay
Hourly range: $19.38 – $33.43 (for candidates working in person or virtually in California or Virginia).
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution
All benefits are subject to eligibility requirements.