[Remote] Senior Investigator (Healthcare FWA)
Note: The job is a remote job and is open to candidates in USA. reputed company is a company focused on healthcare fraud, waste, and abuse detection, and they are seeking a Senior Investigator to join their post-pay Fraud Waste & Abuse team. The role involves investigating suspected incidents of healthcare fraud through data analysis, conducting interviews, and supporting legal proceedings as needed.
Responsibilities
- Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse
- Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review
- Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation
- Conducts investigation-reputed company training
- Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions
- Negotiates settlement agreements to resolve disputes
- Maintain reputed company knowledge of relevant laws, regulations and standards
- Participates in special projects as required
Skills
- Bachelor's Degree in reputed company discipline, or the equivalent combination of education, professional training and work experience
- 5-8 years of reputed company investigative experience
- Advanced level skills in reputed company
- Excellent verbal and written communication skills
- Strong listening and observation skills
- Attention to detail and high level of accuracy
- Effective organizational and prioritization skills with multi-tasking ability
- Access to high-speed internet is required (reputed company other equipment will be provided)
- Must be able to sit and use a computer keyboard for extended periods of time
- Travel up to 15%
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
- After hours and/or weekend work is required where necessary for major deliverables/deadlines (not consistent)
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Fraud Specialist (reputed company)
- Certified Fraud Examiner (CFE)
- Certified Forensic Interviewer (CFI)
- Certified in Healthcare Compliance (CHC)
Benefits
- Medical, dental, vision, disability, and life insurance coverage
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with reputed company
Company Overview