SIU Investigator

We need to output HTML fragment only, with headings

for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Include only sections that have real specific content. Must not repeat job title. Must not include Job ID: we have Position Purpose, Key Details, etc. We need to parse content. We need to remove boilerplate: EEO, equal opportunity, etc. Also remove application instructions (none). Remove duplicated lines. We need to preserve all substantive info. Let's extract sections: Position Purpose: description of role: Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical records, provider information, and other relevant evidence to identify potential misconduct and support case resolution. Document investigative activities, prepare reports and referrals, collaborate with internal and external stakeholders, and support program integrity efforts while ensuring compliance with applicable laws, regulations, contractual obligations, and organizational standards. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT. Then repeated: Conducts fraud, waste, and abuse (FWA) investigations utilizing referrals, claims data, medical records, interviews, data analytics, and other investigative resources to identify potential misconduct and support case resolution. Analyzes, documents, and maintains investigative activities, findings, recommendations, and outcomes in accordance with established procedures, regulatory requirements, and service standards. Reviews claims, medical records, provider billing practices, enrollment information, financial records, and other documentation to identify potential fraud, waste, abuse, overpayments, or compliance concerns. Prepares investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulatory agencies, law enforcement entities, and other authorized parties, as appropriate. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. Supports audits, overpayment identification and recovery efforts, regulatory responses, special projects, and other program integrity initiatives. Maintains compliance with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies and procedures. Monitors for emerging fraud schemes, billing irregularities, and trends that may present risks to healthcare programs and recommend appropriate actions for further review. Supports investigative case progression through onsite audits, visits, drive-by and additional investigative activities such as a member, provider, witness interviews, etc. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience required. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required. Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records to support investigations and case development, preferred preferred. Licenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE)[MF1.1], Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification. preferred Pay Range: $56,200.00 - $101,000.00 per year Then benefits paragraph: At Centene, we connect people... 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. We need to remove EEO etc. We need to create sections: About the role (maybe from Position Purpose and Key Details?). Responsibilities (list of duties). Requirements (education/experience). Qualifications (licenses/certifications). Skills (maybe not explicit; we could infer but we shouldn't invent). Benefits (benefits paragraph). Pay (pay range). Schedule (maybe from flexible approach to work: remote, hybrid, field or office work schedules). That is schedule info. We must not create sections with filler like "not specified". So we include only those with content. We need to use

for each section heading. Use

• for any list of duties/requirements/benefits. Use

  for prose. We must not repeat job title. No markdown. Let's craft. Section About the role: combine Position Purpose and Key Details (visa requirement). Could be prose. Responsibilities: list of duties from the bullet-like sentences after "Conducts fraud..." etc. We'll create

  with each duty as
  • . Requirements: education/experience (Bachelor's degree, 2+ years, experience analyzing...). Could be
    . Qualifications: licenses/certifications (AHFI, CFE, CPC, CPMA, etc). Could be
    . Skills: Not explicitly listed; maybe we could omit if no specific skill list. The instruction: "Prefer a few substantive sections over many thin ones." So we could omit Skills if no explicit skill list. But we might infer skills like "data analytics, interviewing, report writing, collaboration" but that would be inventing. Better to omit. Benefits: list from benefits paragraph: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, flexible approach to work with remote, hybrid, field or office work schedules. Also maybe "additional forms of incentives". We'll list as
    . Pay:

    with pay range. Schedule: maybe from flexible approach to work: remote, hybrid, field or office work schedules. Could be

    . We must not duplicate content; ensure we don't repeat same info in multiple sections. Let's extract duties list precisely: - Conducts fraud, waste, and abuse (FWA) investigations utilizing referrals, claims data, medical records, interviews, data analytics, and other investigative resources to identify potential misconduct and support case resolution. - Analyzes, documents, and maintains investigative activities, findings, recommendations, and outcomes in accordance with established procedures, regulatory requirements, and service standards. - Reviews claims, medical records, provider billing practices, enrollment information, financial records, and other documentation to identify potential fraud, waste, abuse, overpayments, or compliance concerns. - Prepares investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulatory agencies, law enforcement entities, and other authorized parties, as appropriate. - Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. - Supports audits, overpayment identification and recovery efforts, regulatory responses, special projects, and other program integrity initiatives. - Maintains compliance with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies and procedures. - Monitors for emerging fraud schemes, billing irregularities, and trends that may present risks to healthcare programs and recommend appropriate actions for further review. - Supports investigative case progression through onsite audits, visits, drive-by and additional investigative activities such as a member, provider, witness interviews, etc. - Performs other duties as assigned. - Complies with all policies and standards. We could combine some but keep as list. Education/Experience: - Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience required. - 2+ years of Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required. - Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records to support investigations and case development, preferred. Licenses/Certifications: - Accredited Healthcare Fraud Investigator (AHFI) - Certified Fraud Examiner (CFE) - Certified Professional Coder (CPC) - Certified Professional Medical Auditor (CPMA) - Other related investigative, auditing, or compliance certification (preferred) Benefits: - Competitive pay - Health insurance - 401K and stock purchase plans - Tuition reimbursement - Paid time off plus holidays - Flexible approach to work with remote, hybrid, field or office work schedules - Additional forms of incentives (maybe) - Benefits subject to program eligibility. We could include "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." That's more about pay, maybe include in Pay section. Pay section: include range and note about adjustment. Schedule: maybe just note flexible approach to work with remote, hybrid, field or office work schedules. But that's already in benefits. Could move schedule to its own section: "Schedule: Flexible work arrangements including remote, hybrid, field, or office schedules." We must not duplicate. If we put schedule in its own section, we should not repeat in benefits. But benefits already mention flexible approach to work... Could keep benefits without that line, and schedule separate. Let's decide: Benefits list: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, additional forms of incentives, benefits subject to program eligibility. Then Schedule: Flexible work arrangements including remote, hybrid, field, or office schedules. Pay: range and note about adjustment. Now About the role: combine Position Purpose and Key Details (visa requirement). Let's write prose. Now produce HTML. We must not include any extra text outside HTML fragment. Let's craft:

    About the role

    Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical records, provider information, and other relevant evidence to identify potential misconduct and support case resolution. Document investigative activities, prepare reports and referrals, collaborate with internal and external stakeholders, and support program integrity efforts while ensuring compliance with applicable laws, regulations, contractual obligations, and organizational standards. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future; sponsorship is not available for this opportunity.

    Responsibilities

    • Conducts fraud, waste, and abuse (FWA) investigations utilizing referrals, claims data, medical records, interviews, data analytics, and other investigative resources to identify potential misconduct and support case resolution.
    • Analyzes, documents, and maintains investigative activities, findings, recommendations, and outcomes in accordance with established procedures, regulatory requirements, and service standards.
    • Reviews claims, medical records, provider billing practices, enrollment information, financial records, and other documentation to identify potential fraud, waste, abuse, overpayments, or compliance concerns.
    • Prepares investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulatory agencies, law enforcement entities, and other authorized parties, as appropriate.
    • Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
    • Supports audits, overpayment identification and recovery efforts, regulatory responses, special projects, and other program integrity initiatives.
    • Maintains compliance with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies and procedures.
    • Monitors for emerging fraud schemes, billing irregularities, and trends that may present risks to healthcare programs and recommend appropriate actions for further review.