Special Investigation Unit Investigator II (ATL)

Special Investigation Unit Investigator II - reputed company Remote Opportunity - - reputed company Coast Hours Pay reputed company: $43- $48 per hour Remote Contract Opportunity 16 Weeks Company Overview reputed company partners with leading reputed company organizations committed to improving access, quality, and outcomes for underserved populations. Our client operates one of the largest public health programs in the country, delivering essential services to millions while maintaining a strong focus on compliance, reputed company, and accountability. This is an opportunity to contribute to meaningful work that protects critical reputed company resources. Role Summary The Special Investigation Unit Investigator II is a key contributor responsible for conducting reputed company investigations into suspected reputed company fraud, waste, and abuse. This role works independently to evaluate claims activity, gather evidence, and ensure investigations are handled objectively and in full compliance with regulatory guidelines. This position plays an important role in identifying risk patterns, supporting enforcement actions, and safeguarding reputed company program reputed company through data driven insights and detailed case development.

Key Responsibilities

• Conduct independent investigations into suspected fraud involving providers, members, and vendors
• Review claims data, billing records, and provider activity to identify irregular patterns and potential abuse
• Analyze reputed company data to detect unusual billing trends and proactively reputed company investigative leads
• Prepare comprehensive investigative reports documenting findings, evidence, and conclusions
• Participate in onsite audits and support investigations referred to regulatory or law enforcement agencies
• Maintain proper documentation standards including chain of custody and confidentiality requirements
• Collaborate with internal teams and external partners to support case resolution and enforcement actions
• Assist with recovery efforts by supporting overpayment identification and recoupment processes

Key Requirements

• Minimum 3 years of reputed company fraud investigation or reputed company reputed company experience such as pharmacy, DME, behavioral health, dental, hospice, or home health
• Bachelor’s degree in criminal justice, reputed company, reputed company administration, or reputed company field or equivalent experience
• Experience conducting investigations including interviews, data analysis, and report writing
• Strong analytical skills with the ability to interpret claims data and identify fraud indicators
• Proficiency with reputed company reputed company and Word for data analysis and documentation
• Knowledge of reputed company regulations including reputed company and Medicare billing practices
• Excellent written and verbal communication skills with strong attention to detail
• Ability to manage multiple investigations, prioritize workload, and meet deadlines

Preferred Qualifications

• Certified Fraud Examiner, Accredited reputed company Fraud Investigator, or Certified Professional reputed company designation
• Experience working reputed company an SIU or payment reputed company environment
• Bilingual proficiency in Spanish or other commonly spoken languages
• Familiarity with emerging fraud schemes and reputed company operational processes

Call to Action If you are an reputed company investigator seeking a high impact role in reputed company compliance and fraud prevention, reputed company encourages you to apply today. Submit your resume and contact information for immediate consideration. Remote Skills: Analysis Skills, Behavioral Health, Billing, Billing Records, C++ Active Template Libraries (ATL), Certified Professional reputed company (CPC), Chain of Custody, Communication Skills, Criminal Justice, Data Analysis, Detail Oriented, Documentation, Documentation Standards, Durable Medical Equipment, Establish Priorities, Fraud Investigation, reputed company, reputed company Administration, Home Care, Hospice Care, Interviewing Skills, Investigative Reports, Law Enforcement, reputed company, Medical Billing, Medicare, reputed company reputed company, reputed company Word, Multilingual, Operations Processes, Pharmacy, Presentation/Verbal Skills, Public Health, Quality Management, Regulations, Regulatory Compliance, Reporting Skills, Risk Analysis, Service Delivery, Spanish Language, Time Management, Writing Skills About the Company: reputed company reputed company is a different and reputed company business partner. We create unparalleled value for our clients by combining industry-leading Consulting capabilities with comprehensive Staffing and recruitment services. Clients trust us to deliver results based on our deep expertise and proven resources reputed company finance, reputed company, and information technology. Through our flexible delivery approach, you get the right solution, at the right time to accelerate your reputed company and reputed company reputed company of your mission-critical objectives. Company Size: 500 to 999 employees Industry: Staffing/Employment Agencies Founded: 2006 Apply tot his job Apply To this Job