SIU Investigator (Healthcare Fraud)

Location: Remote, Missouri

Salary: $56,200–$101,000 per year

Company

Healthcare organization focused on connecting people with the care they need and improving access and health outcomes.

What you will do

• Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, interviews, data analytics, and other investigative resources.
• Review claims, provider billing practices, enrollment information, financial records, and related documentation to identify fraud, waste, abuse, overpayments, and compliance concerns.
• Document investigative activities, findings, recommendations, outcomes, case summaries, referrals, and supporting evidence.
• Collaborate with compliance, legal, provider and payment integrity teams, regulatory agencies, law enforcement, and other authorized stakeholders.
• Support audits, overpayment identification and recovery, regulatory responses, special projects, and program integrity initiatives.
• Monitor emerging fraud schemes and billing irregularities, including through onsite audits, visits, drive-by activities, and interviews.

Requirements

• Bachelor’s degree in business, criminal justice, healthcare administration, public health, or a related field, or equivalent experience.
• At least 2 years of experience in fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related field.
• Ability to analyze healthcare claims, medical records, billing and coding documentation, provider data, financial information, and related investigative records.
• Ability to comply with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies.

Nice to have

• Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, or financial information.
• AHFI, CFE, CPC, CPMA, or another related investigative, auditing, or compliance certification.

Culture & Benefits

• Remote work arrangement with flexible remote, hybrid, field, or office scheduling options.
• Health insurance, 401(k), stock purchase plan, tuition reimbursement, paid time off, and holidays.
• Equal opportunity workplace committed to diversity and consideration of qualified applicants in accordance with applicable law.