SIU Investigator
Core
Conduct fraud, waste, and abuse (FWA) investigations in healthcare by reviewing claims data, medical records, and provider information to identify misconduct and support case resolution.
Role type
Senior IC healthcare fraud investigator
Builds
Investigative reports, case summaries, and referrals for internal stakeholders, regulatory agencies, and law enforcement
Domain
Healthcare + Fraud Investigation
Required skills
Fraud investigation, claims analysis, medical record review, data analytics, regulatory compliance, stakeholder collaboration, onsite audit execution, trend monitoring
Preferred skills
Healthcare claims experience, billing/coding documentation analysis, financial record review, overpayment recovery support
Technologies
Claims data systems, medical record databases, data analytics tools
Responsibilities
Conduct FWA investigations using referrals, claims data, medical records, interviews, and data analytics; Analyze and document investigative activities and findings; Review claims, medical records, and provider billing practices to identify fraud or compliance concerns; Prepare investigative reports and referrals for internal and external parties; Collaborate with compliance, legal, and payment integrity teams; Support audits, overpayment recovery, and regulatory responses; Monitor for emerging fraud schemes and billing irregularities; Perform onsite audits, visits, and witness interviews.
Seniority
Mid-level, hands-on IC
