Summary of Position: 

Conducts complex, in-depth investigations of reported fraud involving the full range of healthcare products. Provides guidance to the Fraud Investigators conducting anti-fraud training sessions and public speaking engagements.

Responsibilities:

Investigates complex cases of reported fraud involving the Company’s full range of healthcare products. Develops leads from various sources to review for suspect activity. Reviews claim files and develop action plans for the investigation. Conducts highly comprehensive interviews/interrogations with providers. Performs various related duties as assigned, including but is not limited to conduct medical records assessments, and CPT coding issues. Establishes and maintains liaisons with law enforcement, regulatory agencies, and with industry peers. Refers cases to law enforcement agencies as needed. Conducts fraud awareness training sessions and public speaking engagements. Provides guidance to the Fraud Investigators. Answers and responds to SIU Fraud Hotline on rotating basis. Regular attendance is an essential function of the job. Performs other duties as assigned or required.

Qualifications: 

Bachelor’s degree in Criminal Justice  5 years of professional investigation experience with a law enforcement agency required Strong knowledge of CPT and ICD9-CM coding, medical terminology, and treatment options required Additional Information Job Type: Standard Schedule: Full-time Employee Status: Regular Requisition ID: 24059 Hiring Range: $62,200 - $85,000