Senior Investigator, Special Investigations

Job description

Job Description A bit about this role: The Senior Investigator, Special Investigations will play a crucial role in investigating allegations of healthcare fraud, waste, and abuse. This position is responsible for planning, organizing, and executing complex and specialized investigations or audits aimed at preventing, detecting and responding to potential fraudulent activities to protect our members and the Medicare Fund. Your Responsibilities and Impact will include: Perform data mining and analysis to detect aberrancies and outliers in claims, medical records, enrollment records, or other relevant healthcare transactions; independently researches FWA issues and effectively employs investigative resources/techniques. Handle complex investigations that require advanced investigative knowledge/skills. Acts as subject matter expert for SIU Investigator(s), providing specialized knowledge and guidance. Mentor and assist with training SIU staff and internal business partners. Assist in the development and presentation of FWA training. Assist in development of policies and procedures related to fraud, waste, and abuse detection and investigation. Support the development and execution of...