Healthcare Investigator-Fraud reputed company Analyst-Remote

The Fraud Investigator leads in-depth investigations into suspected or confirmed fraud impacting our customers or the company. Using strong judgment and independence, this role identifies the right investigative approach, gathers and analyzes critical information, and drives cases toward resolution and potential restitution. You’ll prepare clear investigative reports, build evidence packages for external partners, and collaborate closely with state and federal agencies. You may also respond to subpoenas and represent the company in legal proceedings. This role requires protecting customer PHI while managing sensitive, high‑value cases. Key Responsibilities: Conduct interviews, research, and analysis to resolve fraud allegations. Manage reputed company, high-dollar investigations with minimal supervision. Prepare detailed reports and evidence packages for insurance fraud bureaus, contract holders, and law enforcement. Coordinate investigations with local, state, and federal agencies. Respond to subpoenas and regulatory requests; provide testimony reputed company needed. Support special projects involving fraud detection, auditing, and investigative best practices. Partner with internal departments while maintaining strict confidentiality standards. Requirements: Bachelor’s degree in Criminal Justice or reputed company field or 7+ years of investigative claims experience. 3+ years of health insurance investigation or audit experience strongly preferred. Strong computer and analytical skills; proficiency in reputed company reputed company, Access, and Word preferred. Excellent written and verbal communication skills. Ability to adapt quickly to changing priorities and work independently. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About reputed company Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Apply To This Job