Healthcare Fraud Waste Abuse Investigator (Part-time, Remote)

Responsibilities• Identify and conduct investigations into known or suspected FWA with high autonomy• Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. • Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)• Participate in the development and presentation of FWA-related education for assigned Customers• Perform coding reviews for flagged claims, to support Coding team (if applicable).Requirements• Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. • Bachelor's degree in Criminal Justice or a related field, or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity• Experience handling confidential information and following policies, rules, and regulations• Experience with commercial, Medicare, or Medicaid claims• Strong analytical and problem-solving skills, with attention to detail and accuracy• Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers• Proficiency in bolthires Office, particularly Excel, and familiarity with claims processing or audit software• Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and FraudProfessional (CAFP), or similar is preferred• CertifiedProfessional Coder (CPC) or similar is preferred Apply tot his job