FRAUD & ABUSE INVESTIGATOR, SR
Do you have experience in Fraud Waste and Abuse?
Or Maybe Special Investigations, Regulatory or Compliance?
Optima Health is seeking a talented individual skilled in investigating and auditing medical and behavioral health for fraud, abuse and cost containment. The ideal candidate will be experienced in Claims Fraud, Waste and Abuse Investigation and ready to lead and train additional members of this very specialized team. This niche role can yield from: law enforcement, nursing, clinical coding, medical coding, claims expertise, external auditing and compliance expertise.
Come and join a company where your work in fraud, abuse and investigations is valued and your career is limitless!
Responsible for leading the SIU efforts, providing oversight and guidance to the team. Conducting in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products at Optima Health.
Bachelor's Level Degree
Required: Coding - 5 years, Healthcare - 5 years, Internal/External Audit - 5 years, Regulatory/Compliance - 5 years
Preferred: None, unless noted in the “Other” section below
Required: None, unless noted in the “Other” section below
Preferred: Cert Professional Coder
None, unless noted in the “Other” section below
Bachelors degree and 5 years related experience required. Related experience includes 5 years Coding OR 5 years Healthcare OR 5 years Internal/External Audit OR 5 years Regulatory/Compliance. CPC required within 12 months of hire. Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred.