SIU Investigator

📋 Description

• Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records
• Review healthcare claims, medical records, provider billing practices, enrollment information
• Analyze, document, and maintain investigative activities, findings, recommendations, and case
• Prepare investigative reports, case summaries, referrals, and supporting documentation for internal
• Collaborate with compliance, legal, provider and payment integrity teams, internal business
• Support audits, overpayment identification and recovery activities, regulatory responses, special

🎯 Requirements

• Bachelor’s degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a
• At least 2 years of experience in fraud, waste, and abuse investigations, healthcare
• Experience analyzing healthcare claims, medical records, provider billing and coding documentation
• Strong analytical and investigative skills, with the ability to identify inconsistencies, translate
• Strong written and verbal communication skills, including the ability to prepare clear
• Excellent attention to detail and project management skills, with the ability to manage multiple

🎁 Benefits

• Salary: $56,200–$101,000 USD per year, with actual compensation determined by skills, experience
• Additional Compensation: Total compensation may include additional incentive opportunities where
• Healthcare: Comprehensive health insurance benefits designed to support employees and their families
• Retirement: 401(k) plan and stock purchase opportunities
• Paid Time Off: Paid time off and holidays to support rest, personal needs, and work-life balance
• Tuition Support: Tuition reimbursement opportunities to encourage continued professional development