Senior Investigator, Special Investigations Unit (Aetna SIU)
Core
Conducts high-level analysis of dental providers and practices to prevent, investigate, and prosecute fraud, waste, and abuse.
Role type
Senior IC fraud investigator (healthcare/dental)
Builds
Evidence packages for corrective action and legal proceedings
Domain
Healthcare + Fraud Investigation
Deliverable
client delivery
Required skills
Data analysis, research, medical terminology, case documentation, law enforcement liaison, testimony preparation
Preferred skills
CFE or AHFI certification, bilingual English/Spanish, clinical or FWA dental experience
Technologies
Microsoft Word, Excel, Outlook, open source database search tools, social media
Responsibilities
Investigate complex dental fraud cases, collaborate with dental networks, communicate with law enforcement, present findings to leadership, provide input on fraud monitoring controls
Seniority
Senior, hands-on IC
