Lead Special Investigation Unit
Job Summary
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
COMPLETE JOB DESCRIPTION
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Company Overview
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