SIU Investigator

Position Purpose

Investigate allegations of potential healthcare fraud and abuse activity.

Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

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 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.

Complies with all policies and standards.

Education/Experience

• Bachelor's degree, or an Associate's degree with an additional 2 years working on health care fraud, waste, and abuse investigations and audits in lieu of a Bachelors is required.
• A minimum of 2 years in a health care field working on fraud, waste, and abuse investigations and audits required.
• The ability to understand and analyze health care claims and coding required.

Pay Range

$56,200.00 - $101,000.00 per year

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.

Qualifications

• Ability to understand and analyze health care claims and coding required.