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Lead Special Investigation Unit
A company is looking for a Lead, Special Investigation Unit (Remote). Key Responsibilities Lead a team of investigators and oversee daily investigative activities Ensure compliance with Medicaid/Medicare/Marketplace health coverage audit policies Review and analyze claims data, medical records, and billing data for potential fraud and abuse Required Qualifications High School diploma or GED 2+ years of experience in healthcare fraud investigations Knowledge of Medicaid/Medicare/Marketplace policies and healthcare coding Healthcare Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Examiner (AHFI), or Certified Fraud Examiner (CFE) preferred Valid driver's license required
A company is looking for a Lead, Special Investigation Unit (Remote).
Key Responsibilities
Lead a team of investigators and oversee daily investigative activities
Ensure compliance with Medicaid/Medicare/Marketplace health coverage audit policies
Review and analyze claims data, medical records, and billing data for potential fraud and abuse
Required Qualifications
High School diploma or GED
2+ years of experience in healthcare fraud investigations
Knowledge of Medicaid/Medicare/Marketplace policies and healthcare coding
Healthcare Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Examiner (AHFI), or Certified Fraud Examiner (CFE) preferred
Valid driver's license required