Investigator, Medical Review Associate

Job description

HealthPartners is hiring a Medical Review Investigator Associate. This role is part of the Special Investigations Unit (SIU) team and supports the identification, assessment, and preliminary analysis of potential Fraud, Waste, and Abuse (FWA) concerns across Medicaid, Medicare, and Commercial (fully insured and self‑funded) lines of business. This role applies analytical judgement and discretion to evaluate allegations, triage incoming referrals, assess risk indicators, and support investigative decision making under the guidance of senior SIU staff. Primary responsibilities include performing structured intake analysis, conducting preliminary review of claims and provider data, assessing documentation and medical record completeness, identifying investigative risks or trends, and supporting prioritization of cases based on defined FWA indicators. This position is a professional, developmental role designed to build investigative competencies and provide exposure to investigative workflows, medical record handling, claims documentation practices, and regulatory process tracking. Successful performance may support progression into SIU investigative roles, subject to business need, d...