Sr Fraud Investigator

Fraud Investigator

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery and litigation. Also, reviews operational controls, and claim system controls and protocols, and recommends enhancements to reduce the potential for fraud.

Job Requirements

• Bachelors Degree
• 5 years law enforcement experience (local, state, or federal) OR 3 years healthcare fraud investigative experience.
• Familiarity with laws applicable to health care fraud.
• Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
• Ability to independently prepare reports of interview and other documentation accurately reflecting investigative activity and results.
• Clear and concise verbal and written communication skills.

Preferred Requirements

Please note that this role is HYBRID with an in-office requirement of 3 days a week.

HCSC Employment Statement :

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$54,800.00 - $121,100.00

Exact compensation may vary based on skills, experience, and location.