Senior SIU Investigator

Centene Corporation

. Independently lead complex fraud, waste, and abuse investigations involving providers, members, pharmacies, vendors, and other entities .

Posted 10/6/2026full-timeRemote • South Carolina • United StatesSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in leading complex fraud, waste, and abuse investigations, with a strong focus on healthcare compliance and regulatory requirements. Proficient in analyzing claims, billing patterns, and medical records while collaborating with various stakeholders to ensure effective case management and resolution.

Highest-signal resume keywords

Fraud InvestigationsHealthcare ComplianceClaims AuditsRegulatory InterpretationInvestigative Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud InvestigationsClaims AuditsData AnalysisInvestigative ReportingRegulatory ComplianceCase ManagementEvidence DocumentationFinancial AnalysisBilling Pattern AnalysisRisk Identification

Soft Skills

CollaborationCommunicationLeadershipTrainingProblem-Solving

Certifications & Qualifications

AHFICFECPCCPMA

Industry Keywords

FraudWasteAbuseHealthcareMedicaidMedicarePayment IntegrityRegulatory RequirementsInvestigative TechniquesCompliance

About the role

Key responsibilities & impact

Independently lead complex fraud, waste, and abuse investigations involving providers, members, pharmacies, vendors, and other entities
Analyze claims, billing patterns, medical records, provider documentation, financial information, and other evidence
Develop investigative strategies, establish case direction, and manage investigations through resolution
Prepare investigative reports, referrals, case summaries, and supporting documentation
Provide subject matter guidance to investigative staff on techniques, documentation, evidence, and regulations
Collaborate with Compliance, Legal, Payment Integrity, Provider Relations, government agencies, and law enforcement partners
Identify emerging fraud schemes, billing irregularities, control gaps, and program integrity risks
Support audits, overpayment identification and recovery, regulatory responses, special projects, and enterprise initiatives
Ensure investigations meet quality, timeliness, documentation, service level, and regulatory requirements
Assist with training, knowledge sharing, and continuous improvement initiatives
Support case progression through onsite audits, visits, drive-bys, and interviews
Perform other duties as assigned and comply with policies and standards

Requirements

What you’ll need

Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience required
4+ years conducting fraud, waste, and abuse investigations, healthcare fraud investigations, claims audits, payment integrity reviews, healthcare compliance investigations, law enforcement investigations, or related investigative work
Experience leading complex investigations involving multiple data sources, extensive analysis, and coordination with internal and external stakeholders
Experience preparing investigative reports, referrals, presentations, and supporting documentation for leadership, regulatory agencies, and law enforcement entities
Experience interpreting and applying federal and state healthcare regulations, including Medicaid, Medicare, and other government-sponsored healthcare programs preferred
Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future
Additional qualifications may be required to satisfy applicable federal, state, regulatory, contractual, or program-specific requirements
AHFI, CFE, CPC, CPMA, or other related investigative, auditing, or compliance certification preferred

Benefits

Comp & perks

Health insurance
401K plan
Stock purchase plan
Tuition reimbursement
Paid time off
Paid holidays
Flexible approach to remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation