Senior SIU Investigator

A company is looking for a Senior SIU Investigator to investigate allegations of healthcare fraud and abuse activity.

Key Responsibilities

Investigate allegations of healthcare fraud, waste, and abuse, documenting findings and referring issues as necessary

Perform data mining and analysis to detect irregularities in claims and develop internal reports on findings

Coordinate with Health Plans and prepare detailed reports for referral to Federal and State agencies

Required Qualifications

Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience

3+ years of experience in medical claim investigation, audit, analysis, or fraud investigation

Knowledge of Microsoft Applications, medical coding, and claims processing preferred

Certified Professional Coder certification preferred