SIU Investigator

Position Purpose

Please note: candidates must reside in Arkansas.

Responsibilities

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• Perform data mining and analysis to detect aberrancies and outliers in claims
• Develop new queries and reports to detect potential waste, abuse, and fraud
• Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
• Assist with complex allegations of healthcare fraud
• Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
• Complete various special projects and audits

Requirements

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
• 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Qualifications

• Complies with all policies and standards

Skills

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Proficiency in data mining and analysis tools

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

Pay

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Schedule

Details on schedule will be provided upon hire.

Benefits

• May be subject to program eligibility