SIU Investigator (Healthcare)

TL;DR

SIU Investigator (Healthcare): Leading complex investigations into healthcare fraud, waste, and abuse (FWA) with an accent on data-driven detection and regulatory compliance. Focus on identifying anomalies in medical claims, collaborating with federal agencies, and safeguarding the integrity of Medicare and Medicaid programs.

Location: Must be based in the USA

Salary: $58,000 - $90,000 /year

Company

hirify.global is an all-in-one healthcare company dedicated to improving the well-being of older Americans by integrating compassion, insurance, and technology.

What you will do

• Lead the full lifecycle of complex FWA investigations, from planning to final reporting.
• Utilize advanced data mining and AI tools to identify aberrancies in claims and medical records.
• Collaborate with internal stakeholders and external federal/state agencies to facilitate fund recovery.
• Provide expert guidance to the SIU team and contribute to risk assessment strategies.
• Conduct provider education sessions based on audit and investigation findings.
• Serve as a primary point of contact for corporate and field inquiries regarding FWA.

Requirements

• Must be based in the USA
• Bachelor’s degree in Business, Criminal Justice, Healthcare, or equivalent experience.
• Minimum 3 years of dedicated health insurance fraud investigation experience.
• Minimum 5+ years of experience as a detective or investigator for a law enforcement agency.
• Proven experience with Medicare/Medicaid programs, medical billing, and reimbursement.
• Demonstrated experience with data analysis techniques and AI tools.

Nice to have

• Certified Fraud Examiner (CFE) certification.
• Certified Professional Coder (CPC) certification.
• Experience with the Healthcare Fraud Shield platform.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• 401K program and stock options for all employees.
• Generous paid time off and parental leave program.
• $100 monthly mobile or internet stipend.
• Bonus eligibility for eligible roles.