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 and obtain statements from witnesses and others
• Complete complex investigative reports applying regulations or rules to affected programs
• Apply federal or state laws as needed
• Research and understand relevant offenses
• Conduct investigations concerning alleged offenses and detect or verify suspected violations
• Obtain information and evidence through observation, record examination, and interview
• Analyze investigation results to determine whether allegations are corroborated
• Determine appropriate steps with others to address identified issues
• Prepare correspondence and communicate objectively, accurately, and tactfully
• Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
• 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

Fraud Investigator jobs in South Carolina

Fraud Investigator – Medicare