SIU Investigator (Healthcare Fraud)

Location: Remote-NY; candidates residing in New York are highly preferred. U.S. work authorization is required, and employment-based visa sponsorship is not available.

Salary: $56,200–$101,000 per year

Company

A healthcare organization focused on connecting people with the care they need and improving healthcare access and 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, and case progression in accordance with procedures and regulatory requirements.
• Prepare investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulators, law enforcement, and other authorized parties.
• Collaborate with compliance, legal, provider and payment integrity teams, external agencies, and other stakeholders on corrective actions, recoveries, audits, and case resolution.
• Monitor emerging fraud schemes and billing irregularities, and conduct onsite audits, visits, and interviews with members, providers, and witnesses.

Requirements

• Bachelor’s degree in business, criminal justice, healthcare, or a related field, or equivalent experience.
• At least 5 years of healthcare fraud, waste and abuse investigation or audit experience; insurance claims investigation or professional law enforcement investigation experience may also qualify.
• Alternatively, at least 7 years of professional investigation experience involving economic or insurance-related matters.
• Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, or financial information is preferred.
• Must be authorized to work in the United States without current or future employment-based visa sponsorship.

Culture & Benefits

• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work schedules that may include remote, hybrid, field, or office arrangements.
• Work focused on healthcare program integrity, compliance, and improving access to care.
• Equal opportunity employment and consideration of qualified applicants in accordance with applicable law.