SIU Investigator (Healthcare Fraud)

Location: Remote in the United States; candidates residing in Florida are highly preferred

Salary: $56,200–$101,000 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Investigate allegations of healthcare waste, abuse, and fraud.
• Plan, organize, and execute claims investigations and audits.
• Document case activity, provide progress updates, and refer issues to appropriate parties.
• Perform data mining and claims analysis to identify aberrancies and outliers.
• Develop queries and reports to detect potential fraud, waste, and abuse.
• Prepare investigative findings for referral to Federal and State agencies and coordinate recommendations with Health Plans.

Requirements

• Bachelor's degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience.
• At least 1 year of experience in medical claim investigation, medical claim auditing, medical claim analysis, or fraud investigation.
• Residence in Florida is highly preferred.

Culture & Benefits

• Remote, hybrid, field, and office work schedules may be available depending on the role and circumstances.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Compensation may vary based on skills, experience, education, and other job-related factors.