Job Details

A company is looking for a Special Investigation Unit Investigator to investigate allegations of potential healthcare fraud and abuse activity.Key ResponsibilitiesConduct investigations of potential waste, abuse, and fraudDocument activity on each case and refer issues to the appropriate partyPerform data mining and analysis to detect aberrancies and outliers in claimsRequired Qualifications, Training, and EducationBachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience required1+ years of experience in medical claim investigation, audit, analysis, or fraud investigation requiredSpecific experience requirements for candidates in New York, Kentucky, Ohio, Nebraska, New Jersey, and North Carolina plansExperience in healthcare fraud, waste, and abuse investigations may vary by stateAdditional qualifications may include relevant degrees or certifications based on state-specific requirements