Senior Investigator

Highmark Health

Base: $72,700.00 - $116,600.00; bonus/equity: not ...
Onsite
5 years health insurance industry experience
Healthcare fraud investigation expertise
Provider facility payment methodology knowledge
The incumbent is responsible for developing and maintaining an anti-fraud program including training delivery and filing of Fraud Plans

Job Summary

  • The incumbent is responsible for developing and maintaining an anti-fraud program including training delivery and filing of Fraud Plans.
  • This role requires conducting investigations into alleged fraud, waste, and abuse involving providers, members, and employees while coordinating recoveries.
  • Candidates must possess the ability to testify in court of law and prepare cases for referral to federal, state, and local law enforcement entities.

Matching Summary

The incumbent is responsible for developing and maintaining an anti-fraud program including training delivery and filing of Fraud Plans.

Salary

Base: $72,700.00 - $116,600.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • 5 years health insurance industry experience
  • Healthcare fraud investigation expertise
  • Provider facility payment methodology knowledge
  • Claims processing systems proficiency
  • Court testimony capability
  • Data mining tools usage

Nice-to-have

  • Project leadership experience
  • Financial analysis in acute care setting
  • Mentoring and training team members
  • Strategic problem-solving capabilities
  • Strong relationship building skills

Key Requirements

  • Bachelor's degree in Accounting, Finance, Nursing, or related field
  • 5 years in Health insurance industry or Healthcare fraud investigations
  • 1 year of leading projects of varying size and complexity
  • Preferred Master's Degree in Fraud, Forensics Accounting, or Business
  • Preferred Certified Fraud Examiner (CFE) certification

Work Rights

Not specified

Tailored Resume

Cover Letter