SIU Investigator
Core
Investigate allegations of healthcare fraud, waste, and abuse by analyzing claims data, provider files, and records to uncover billing irregularities and compliance issues.
Role type
Senior SIU Investigator (Healthcare Fraud)
Builds
Fraud detection reports, case documentation, and compliance findings for healthcare clients.
Domain
Healthcare / Healthcare Fraud & Abuse
Deliverable
client delivery
Required skills
Claims data analysis, investigative research, report writing, onsite audit execution, regulatory compliance knowledge, database examination, stakeholder relationship management, workflow improvement, knowledge sharing, fraud trend analysis
Preferred skills
Experience in similar roles, relevant education or training
Technologies
Claims systems, provider files, related databases, AI LESS
Responsibilities
Review allegations and complex matters involving potential healthcare fraud, waste, and abuse; analyze claims data and provider details to identify billing irregularities; research and collect information from internal and external sources; document investigative work, findings, and evidence in clear reports; examine claims systems and databases for compliance issues; participate in onsite reviews and audits; maintain case documentation per policy and regulatory standards; prepare reports for internal partners and regulatory teams; respond to information requests and support case tracking; participate in industry meetings and professional development; apply subject matter expertise to support business operations and process improvements; provide guidance and training to team members.