FRAUD & ABUSE INVESTIGATOR, SR - Alabama Community Care Team
Optima Health has an opening for a Fraud & Abuse Investigator. This position is full time, day shift, with the potential for a remote option for residents in Virginia and North Carolina. This is an exciting opportunity to work in support of our new Alabama Community Care expansion team located in Virginia Beach, VA.
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.