Senior Investigator, Special Investigations Unit (Aetna SIU)
Core
Senior Healthcare Fraud Investigator managing complex investigations into suspected and known acts of healthcare fraud, waste, and abuse to prevent fraudulent payments and recover lost funds.
Role type
Senior IC healthcare fraud investigator
Builds
Case files, evidence packages, and referrals to law enforcement for prosecution
Domain
Healthcare insurance, fraud detection, legal compliance
Deliverable
client delivery
Required skills
Healthcare fraud investigation, case management, legal research, evidence development, trial testimony, law enforcement cooperation, data analysis, written reporting
Preferred skills
Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), AHFI certification, self-funded insurance plan operations knowledge
Technologies
Microsoft Word, Excel, Outlook, open source database search tools, social media research tools
Responsibilities
Conduct high-level complex investigations of suspected healthcare fraud, prepare cases for clinical and legal review, document case activity, prepare written summaries for state/federal agencies, facilitate recovery of lost funds, cooperate with law enforcement, provide trial testimony, present to internal/external customers
Seniority
Senior, hands-on IC
