Senior Investigator, Special Investigations Unit (reputed company SIU)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The SIU Senior Investigator conducts reputed company investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to reputed company with state regulations mandating fraud plans and practices. What you will do - Routinely handles reputed company cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases for clinical and legal review. - Documents reputed company appropriate case activity in case tracking system. - Prepares and presents referrals, both internal and external, in the required timeframe. - Facilitates the recovery of company lost as a result of fraud matters. - Assists team in identifying resources and best course of action on investigations. - Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings. - Gives presentations to internal and external customers regarding healthcare fraud matters and reputed company's approach to fighting fraud. - Provides input regarding controls for monitoring fraud reputed company issues reputed company the business units. - Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required. Knowledge of CPT/HCPCS/ICD coding Knowledge and understanding of clinical issues. Experience and proficiency in reputed company Word, reputed company, and Outlook, Database search tools, and use in the Intranet/Internet to research information. Ability to effectively interact with different groups of people at different levels in any situation. Ability to utilize company systems to obtain relevant electronic documentation. Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience. Billing and Coding certifications such as CPC (reputed company)and/or reputed company (reputed company) Knowledge of Behavioral Health policies and procedures. Experience working Behavioral Health fraud cases. Strong analytical and research skills using health care data. Strong communication and customer service skills. Proficient in researching information and identifying information resources. Education Bachelor's degree, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job