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.

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, 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.

Qualifications

Complies with all policies and standards.

Benefits

Comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. 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. Benefits may be subject to program eligibility.

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

Flexible approach to work with remote, hybrid, field or office work schedules.