Job Summary

• The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data.
• You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior.
• Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Matching Summary

Salary

New Jersey and New York: $72,036 - $94,546; Other locations: $64,832 - $85,092; Benefits: Medical, dental, vision, holidays, sick time, parental leave, 401(k), life/disability insurance, wellness time/reimbursements

Skills & Requirements

Key Requirements

• 3+ years healthcare fraud investigation experience
• 3+ years experience with fraud statutes and regulations
• 3+ years experience with federal guidelines on recoupments

Work Rights