SIU Investigator III (Must live in MA or surrounding states)
CareSource(2 months ago)
About this role
The Special Investigations Unit (SIU) III is a senior-level investigator responsible for identifying, researching and resolving complex allegations of healthcare fraud, waste, and abuse. The role leverages claims, clinical, pharmacy and eligibility data to detect billing aberrancies and develops case outcomes and recommendations. The position serves as a subject matter expert and collaborates with internal and external partners, including legal and law enforcement. Qualified candidates must reside in Massachusetts or surrounding states.
Required Skills
- Fraud Investigation
- Data Analysis
- Medical Coding
- Claims Analysis
- Auditing
- Report Writing
- Interviewing
- Case Management
- Regulatory Knowledge
- Project Management
+2 more
Qualifications
- Bachelor's Degree
- Master's Degree (Preferred)
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Certified Professional Coder (CPC) (Preferred)
- NHCAA Training (Preferred)
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