Senior Investigator

A company is looking for a Senior Investigator to conduct audits and investigations into healthcare claims. Key Responsibilities Conduct detailed audits and investigations into potential fraud, waste, and abuse within healthcare claims Review medical records, verify charges, and generate audit reports Collaborate with clients to deliver audit results and support case building Required Qualifications Expertise in Audit Management, Quality Assurance, and Corporate Integrity Agreements Experience with Medical Necessity Review, Proper Coding/Documentation, and Reporting Ability to work with healthcare personnel while demonstrating ethical behavior and maintaining confidentiality Bachelor's degree in a related field; advanced certifications in auditing or healthcare compliance are beneficial Familiarity with OIG best practices and Big-4 Data Analytics is a plus

Mar 7, 2025 - 18:22

A company is looking for a Senior Investigator to conduct audits and investigations into healthcare claims. Key Responsibilities Conduct detailed audits and investigations into potential fraud, waste, and abuse within healthcare claims Review medical records, verify charges, and generate audit reports Collaborate with clients to deliver audit results and support case building Required Qualifications Expertise in Audit Management, Quality Assurance, and Corporate Integrity Agreements Experience with Medical Necessity Review, Proper Coding/Documentation, and Reporting Ability to work with healthcare personnel while demonstrating ethical behavior and maintaining confidentiality Bachelor's degree in a related field; advanced certifications in auditing or healthcare compliance are beneficial Familiarity with OIG best practices and Big-4 Data Analytics is a plus