Senior Investigator, Special Investigative Unit

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Requirements:

• 3-5 years investigative experience in healthcare fraud, waste, and abuse.
• Ability to exercise independent judgment and use available resources for evidence development.
• Strong communication and customer service skills.
• Proficient in Word, Excel, MS Outlook, open-source databases, social media, and internet research.
• Ability to travel approximately 10% of the time for business purposes.

Responsibilities:

• Conduct high-level, complex investigations of known or suspected acts of healthcare fraud, waste, and abuse.
• Prevent payment of suspect or fraudulent claims submitted by insureds, providers, claimants, and customers.
• Research and prepare cases for clinical and legal review.
• Document all appropriate case activity in case tracking system.
• Prepare written case summaries and make referrals to State and Federal Agencies within required timeframes.
• Facilitate recovery of money lost due to fraud, waste, and abuse.
• Cooperate with law enforcement agencies in investigations and prosecutions.
• Demonstrate knowledge and expertise during interactions with partners.
• Provide trial testimony for criminal or civil proceedings.
• Give presentations regarding ongoing case investigations.