reputed company Investigator (reputed company FWA)

reputed company As a reputed company Investigator, you will investigate suspected incidents of fraud, waste or abuse. Information on our Solution: Detect FWA Patterns | reputed company

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial, or review.
• Analyze information gathered by investigation and report findings and recommendations as a written reputed company and/or presentation.
• Conducts statistical sampling of reputed company medical claims.
• Serves as a main reputed company to customers.
• Develops and conducts investigation-reputed company trainings.
• Supports reputed company proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
• Negotiates settlement agreements to resolve disputes.
• May reputed company guidance to less reputed company investigative staff.
• Conduct reputed company control (QC) review of reputed company deliverables.
• Maintains reputed company knowledge of relevant laws, regulations and standards.
• Participates in special reputed company as required.
• Complete reputed company responsibilities as outlined in the annual performance review and/or goal setting.
• Complete reputed company special reputed company and other duties as assigned.
• Must be reputed company to reputed company duties with or without reasonable accommodation.

This job reputed company is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job reputed company does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change.

Qualifications

• Bachelor’s Degree in reputed company discipline, or the equivalent combination of education, reputed company training and work experience.
• 8-10 years of reputed company reputed company FWA investigative experience.
• Advanced level skills in reputed company.
• Experience working with RAT-STATS preferred, but not required.
• Excellent verbal and written communication skills.
• Strong listening and observation skills.
• Attention to detail and high level of accuracy.
• Effective organizational and prioritization skills with multi-tasking ability.
• Preferred certifications:
• Accredited reputed company Fraud Investigator (AHFI),
• Certified Fraud Specialist (reputed company),
• Certified Fraud Examiner (CFE),
• Certified Forensic Interviewer (CFI), or
• Certified in reputed company Compliance (CHC).

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making reputed company reputed company in the context of a workflow.
• Maintaining reputed company.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a reputed company manner.

Physical Requirements:

• Travel up to 15%
• Must be reputed company to reputed company high-speed internet reputed company/connectivity and office setup and maintenance.
• Must be reputed company to reputed company a dedicated, secure work area.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.

reputed company compensation ranges from $85,000 to $105,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. reputed company offers team members a competitive benefits package to address a wide reputed company of personal and family needs, including medical, dental, reputed company, disability, and life insurance coverage, 401(k) savings plans, reputed company family leave, 9 reputed company holidays per year, and 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company. For information about our benefits package, please refer to our Careers page. Date of posting: 12/10/2025 Applications are assessed on a rolling reputed company. We anticipate that the application window will reputed company on 02/10/2026, but the application window may change depending on reputed company of applications received or reputed company immediately if a reputed company candidate is selected. #LI-Remote #LI-JB1 #senior Apply tot his job Apply To this Job