Investigator

• Conduct high-level, complex investigations of suspected healthcare fraud and abuse
• Investigate program-integrity matters involving aberrant Medicaid claims
• Research subjects and related entities
• Independently conduct proactive data mining using SIU tools
• Analyze claims data to identify aberrancy, patterns, and schemes
• Research and prepare cases for clinical and legal review
• Collaborate with Medical Directors on clinical issues and medical-record questions
• Document case activity and communications in the designated tracking system
• Communicate clinical findings to providers
• Adhere to regulatory requirements
• Facilitate recovery of company and customer funds lost through aberrant billing
• Train and guide new and junior investigators
• Assist junior investigators with resources and investigative strategy
• Serve as backup to the Team Leader as needed
• Collaborate with federal, state, and local law-enforcement agencies on healthcare-fraud investigations and prosecutions
• Present healthcare-fraud findings and FWA knowledge to internal and external stakeholders
• Testify in civil and criminal proceedings
• Develop professional presentations on healthcare fraud matters and enterprise FWA approaches
• Recommend efficiency gains and provide input on FWA monitoring controls

Investigator jobs in Oklahoma

Senior Investigator, Special Investigations Unit – SIU