Fraud Investigator

• Perform high-level complex investigations of medical professional service providers
• Develop cases for referral to law enforcement, education, overpayment recovery, and other administrative actions
• Work with internal resources and external agencies to develop cases and corrective actions
• Respond to requests for data and support
• Handle multiple caseload assignments concurrently
• Organize and analyze complex evidentiary patterns
• Interview witnesses and others and obtain statements
• Complete complex investigative reports applying applicable regulations, rules, and laws
• Research relevant offenses and conduct investigations to detect or verify suspected violations
• Obtain information and evidence through observation, record examination, and interview
• Analyze investigation results and determine appropriate corrective steps
• Prepare correspondence and referral summary letters
• Maintain confidentiality of health privacy information
• Conduct site verifications to verify provider operational status
• Appear in court to testify about work findings when required
• Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
• Report work activity in a timely manner
• Attend meetings, training, and conferences

Fraud Investigator – Medicare

• Conduct investigations into account takeovers, payment fraud, phishing, and organized fraud rings
• Analyze patterns of fraudulent transactions and abusive conduct
• Dispute chargebacks, gathering evidence to minimize financial loss and maximize recovery
• Analyze identity verification and background checks
• Triage and resolve account safety-related incidents, including flagged content, harassment, and Terms of Service violations
• Manage and action appeal requests for deactivated accounts
• Serve as a subject matter expert on fraud and identity verification
• Work cross-functionally with operations partners on enterprise-wide initiatives
• Investigate potential fraud in high-volume queues
• Identify fraud trends and contribute to scalable proactive detection
• Summarize and communicate investigation results, findings, and insights to leaders and stakeholders

Fraud Investigator jobs in Florida

Fraud Investigator – Medicare

Fraud Investigator II