Senior Investigator, Special Investigations Unit (Aetna SIU)

Position Summary

The Senior Investigator, Aetna Special Investigations Unit, conducts high-level, complex investigations of healthcare fraud and abuse. This role handles national and multi-line cases, identifies aberrant billing patterns, and collaborates with medical directors and law enforcement.

Required Qualifications

• 3+ years investigative experience in healthcare fraud and abuse matters
• Working knowledge of medical coding; CPT, HCPCS, ICD10
• Proficient in Microsoft Office with advanced skills in Excel (pivot tables are a must)
• Strong analytical ability to view and slice claims data in multiple facets
• Self-starter: initiates research that supports investigations
• Ability to travel up to 10%

Preferred Qualifications

• 5+ years investigative experience in healthcare fraud and abuse matters
• Medicaid/Medicare investigation experience; knowledge of applicable rules and regulations
• Exercises independent judgement; uses available resources and technology in developing evidence
• Knowledge and understanding of complex clinical issues

Education

• Bachelor's degree or equivalent experience (5+ years of working health care fraud, waste and abuse investigations)

Pay Range

The typical pay range for this role is $46,988.00 - $112,200.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.