Junior Healthcare Fraud Investigator - Remote

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Requirements:

• 2+ years’ experience in health insurance fraud investigation or audit preferred.
• Associates Degree required; Bachelor's Degree in Criminal Justice or related field strongly preferred.
• Experience in leading investigations, data analysis, report writing, and presenting findings is highly preferred.
• Clear and concise verbal and written communication skills are necessary.
• Strong computer skills required, particularly in Excel, Access, and Word.
• Attention to detail and strong analytical and critical thinking skills are essential.
• Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) certification are preferred.

Responsibilities:

• Analyze information gathered from investigations and audits, reporting findings and preparing summaries.
• Prepare evidence packages for referral to contract holders, insurance fraud bureaus, and law enforcement.
• Lead inspections and patient/provider interviews as needed.
• Respond to subpoenas and law enforcement requests, potentially serving as a witness in judicial proceedings.
• Conduct special projects requiring expertise in fraud detection and investigation.
• Prepare reports to expedite tracking and reporting of investigations.