SIU Investigator (Healthcare Fraud)

Location: Remote-NV

Salary: $56,200–$101,000 per year

Company

hirify.global connects people with healthcare services and works to improve access and health outcomes for individuals, families, and communities.

What you will do

• Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, interviews, provider information, and data analytics.
• Review claims, billing and coding records, enrollment information, financial documentation, and provider practices to identify fraud, waste, abuse, overpayments, and compliance concerns.
• Document investigative activities, findings, recommendations, and outcomes according to 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, business partners, and external agencies on corrective actions, recoveries, audits, and case resolution.
• Monitor emerging fraud schemes and support onsite audits, field visits, interviews, regulatory responses, and program integrity projects.

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, and financial information.
• Ability to maintain compliance with federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies.

Nice to have

• Experience supporting investigations through healthcare claims, medical records, provider billing, financial analysis, or related case-development work.
• AHFI, CFE, CPC, CPMA, or another relevant investigative, auditing, or compliance certification.

Culture & Benefits

• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible work approaches that may include remote, hybrid, field, or office schedules.
• Equal opportunity workplace committed to diversity and inclusion.