Job Details

A company is looking for an Investigator III to lead complex investigations into allegations of fraud, waste, and abuse in healthcare.Key ResponsibilitiesAnalyze healthcare claim data to detect fraudulent activity and determine investigation methodsConduct investigative fieldwork including office visits, record collection, and surveillancePrepare cases for potential criminal prosecution and participate in settlement negotiationsRequired Qualifications and EducationBachelor's degree in business administration, healthcare administration, finance, accounting, nursing, or criminal justice, or 4 years of relevant work experience3 years of experience in fraud investigation or a related fieldCertification as a Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI)2 years of active experience in auditing and investigating within the healthcare industrySignificant experience with relevant technology, including fraud detection software and claims processing platforms