Special Investigation Unit Investigator IIIJoin our team as a Special Investigation Unit Investigator III in a remote, contract position. You will conduct detailed evaluations of potential fraud and abuse cases, leading complex investigations. The role requires strong analytical skills and expertise in investigative techniques, utilizing various data analysis tools. Perform in-depth evaluations of potential fraud and abuse cases involving high dollar amounts. Develop and lead complex investigations, providing mentorship and training to junior investigators. Ensure adherence to policies and procedures across all product offerings. Conduct investigation-related training and serve as a subject matter expert. Compile and maintain comprehensive documentation and reporting requirements. Participate in hearings and appeals, and testify as a witness in court proceedings. Develop and maintain strong working relationships with regulatory bodies and law enforcement.
Key Responsibilities:
Investigate allegations of healthcare fraud by providers or members. Analyze data to detect unusual billing patterns and initiate appropriate actions. Write comprehensive reports documenting interviews and findings. Lead onsite audits and manage cases referred to law enforcement. Enhance investigative skills and mentor less experienced team members.
Qualifications:
Bachelor's Degree in Criminal Justice or related field, or equivalent experience. Minimum of 5 years of experience in healthcare fraud investigation/detection. Proficient in managing large data sets and performing complex calculations. Excellent communication skills, both verbal and written. Certified Fraud Examiner (CFE) or similar certification preferred. Core Technologies Data Analysis Tools | Word Processing Software | Spreadsheet Software
