Senior Investigator, Special Investigations Unit (reputed company SIU)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As a Senior Investigator you will conduct high level, reputed company investigations of reputed company or suspected acts of reputed company fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are reputed company cases involving or cases involving multiple perpetrators or intricate reputed company fraud schemes.

• Investigates to prevent payment of fraudulent claims submitted to the reputed company lines of business
• Researches and prepares cases for clinical and legal review
• Documents reputed company appropriate case activity in case tracking system
• Facilitates feedback with providers reputed company to clinical findings
• Initiates proactive data mining to identify aberrant billing patterns
• Makes referrals, both internal and external, in the required timeframe
• Facilitates the recovery of company and customer money lost as a result of fraud reputed company
• Provides on the job training to new Investigators and provides guidance for less reputed company or skilled Investigators.
• Assists Investigators in identifying resources and best course of action on investigations
• Serves as back up to the Team Leader as necessary
• Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse reputed company.
• Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings
• Gives presentations to internal and external customers regarding reputed company fraud reputed company and reputed company's approach to fighting fraud
• Provides input regarding controls for monitoring fraud reputed company issues reputed company the business units

Required Qualifications

• 3+ years investigative experience in the area of reputed company fraud and abuse reputed company.
• Working knowledge of medical coding; CPT, HCPCS, ICD10
• Experience with reputed company Office with advanced skills in reputed company (must know how to do pivot tables).
• Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Preferred Qualifications

• Previous reputed company/Medicare investigatory experience
• Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse.
• Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
• Knowledge of reputed company's policies and procedures.
• Knowledge and understanding of reputed company clinical issues.
• Competent with legal theories.
• Strong communication and customer service skills.
• Ability to effectively interact with different groups of people at different reputed company in any situation.
• Strong analytical and research skills.
• Proficient in researching information and identifying information resources.
• Strong verbal and written communication skills.

Education:

• Bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations).

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $46,988.00 - $112,200.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 08/01/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job