Senior SIU Investigator - CPC Required
Core
Senior investigator managing comprehensive fraud, waste, and abuse investigations in healthcare, analyzing claims data, conducting audits, and recovering losses.
Role type
Senior IC fraud investigator (healthcare)
Builds
Investigative reports, case resolutions, and cost containment recommendations for a healthcare insurance company.
Domain
Healthcare insurance + fraud detection
Required skills
Fraud investigation, data analysis, audit planning, interview techniques, regulatory knowledge (Medicare/Medicaid), coding conventions, report writing, case resolution, settlement negotiation, process improvement
Preferred skills
AHFI certification, CFE certification, CPC certification, Lean Six Sigma Black Belt, Registered Nurse licensure
Technologies
Microsoft Excel, Access, Outlook, Word, PowerPoint
Responsibilities
Prioritize and manage investigative workload; analyze claims and provider data to detect suspicious patterns; conduct desk and field audits; interview patients, providers, and witnesses; prepare detailed investigative reports; negotiate settlement agreements; present cases to law enforcement and regulatory agencies; train junior investigators; develop anti-fraud policies.
Seniority
Senior, hands-on IC
