Investigator Ii

Harvard Pilgrim Health Care Inc

Base: $80,125.38 - $120,188.06; bonus/equity: vari...
Fully remote
3-5 years health insurance experience
Fraud waste and abuse investigation skills
Medical record review expertise
Harvard Pilgrim Health Care Inc is seeking an Investigator II for its Special Investigation Unit (SIU) to lead investigations related to fraud, waste, and abuse in healthcare. The ideal candidate should have relevant experience and certifications, with a focus on collaborative problem-solving and innovation

Job Summary

  • The Investigator II is responsible for leading complex provider investigations related to fraud, waste, and abuse within the Special Investigation Unit.
  • Candidates must apply laws, regulations, and coding rules to gather information and prepare detailed reports of investigative activity.
  • Point32Health offers a competitive total rewards package including medical, dental, vision, retirement plans, and paid time off.

Matching Summary

Match Score: 85

Harvard Pilgrim Health Care Inc is seeking an Investigator II for its Special Investigation Unit (SIU) to lead investigations related to fraud, waste, and abuse in healthcare. The ideal candidate should have relevant experience and certifications, with a focus on collaborative problem-solving and innovation.

Salary

Base: $80,125.38 - $120,188.06; Bonus/Equity: Variable pay eligible; Benefits: Comprehensive total rewards including medical, dental, vision, and retirement

Skills & Requirements

Must-have

  • 3-5 years health insurance experience
  • Fraud Waste and Abuse investigation skills
  • Medical record review expertise
  • Data analysis for investigative findings
  • Provider interview and reporting

Nice-to-have

  • Certified Fraud Examiner designation
  • Clinical or scientific degree background
  • Experience drafting summary findings notices
  • Collaborative and innovative mindset
  • Resilient and flexible work style

Key Requirements

  • Bachelor's degree required
  • 3-5 years related experience in health insurance or fraud investigations
  • Certified Professional Coder (CPC) certification
  • Certified Fraud Examiner (CFE) designation preferred

Work Rights

Not specified

Tailored Resume

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