Investigator, Special Investigations Unit | Remote

Job description

The Investigator within the Special Investigations Unit (SIU) will be responsible for effectively carrying out complex investigations of alleged misconduct and Fraud, Waste and Abuse by providers, representatives, employees, members, and others. This position is 100% remote. Scope of Responsibilities: Conduct investigations of Providers, Representatives, Employees, Members, contracted groups and others Compile data into written reports: collect, utilize & interpret data obtained from a variety of reports and other sources, thereby identifying & documenting questionable patterns related to operation, and other practices which merit further investigation Investigations may be of a more complex nature i.e., multiple allegations; Medicaid and Medicare investigations or investigations involving extensive research, income verifications, and other criteria for eligibility Research investigations; prepare, review and edit investigation reports for submission to AVP, SIU and Marketing Incidents Committee Present relevant investigative findings: prepare and deliver presentation summaries to the Marketing Incidents Committee, and/or other groups as needed Log investigations, ensure accuracy,...