Health Insurance Investigator (Open to hiring at the Sr. level)

Reporting to the Team Leader of SIU & Compliance, you will identify and investigate suspected provider and member health insurance fraud, waste and abuse, identify potential losses and recoveries for the corporation, prepare reports of suspected fraud, waste and abuse, and work with law enforcement agencies and anti-fraud organizations, as appropriate. Investigations must be conducted in accordance with company policies and procedures and in compliance with all applicable laws and regulations. Ideal candidates will have experience in health insurance operations, with a foundational knowledge of applicable rules/regulations and medical terminology, including coding. You have exceptional attention to detail and identify as meticulous and methodical. You do not seek immediate gratification in your work; you embrace patience and are comfortable with dedicating time before you see results. You love to research – whether with existing content or collaborating with other stakeholders. You have excellent written and verbal communication skills and a demonstrated history of building meaningful, professional relationships. You are naturally curious, inquisitive and willing to ask questions to achieve goals focused on the desired outcomes. Analyzing complex information and articulating it in a digestible manner comes easily and you gain energy from a day that requires the evaluations of facts to determine next steps.