Senior Investigator, Special Investigations Unit (SIU) - Must reside in Oklahoma
Core
Conduct high-level, complex investigations of known or suspected healthcare fraud and abuse, including data mining and claims analysis for Medicaid lines of business.
Role type
Senior IC healthcare fraud investigator
Builds
Case files and evidence for clinical and legal review to recover lost monies
Domain
Healthcare / Insurance / Fraud Investigation
Required skills
Healthcare fraud investigation, Data mining, Claims data analysis, Medical coding (CPT, HCPCS, ICD10), Microsoft Excel (pivot tables), Witness testimony, Regulatory compliance
Preferred skills
Medicaid/Medicare investigation experience, CFE or AHFI certification, Clinical issue knowledge, Independent judgement
Technologies
SIU Tools, Power BI, Microsoft Office
Responsibilities
Investigate program integrity to prevent aberrant claim payments, Conduct research on subjects and entities, Initiate proactive data mining to identify billing patterns, Analyze claims data for aberrancy, Prepare cases for clinical and legal review, Collaborate with law enforcement agencies, Testify in civil and criminal proceedings, Train junior investigators
Seniority
Senior, hands-on IC
