SIU Program Integrity Investigator - Remote (In Idaho)
Magellan Health(1 month ago)
About this role
The SIU Program Integrity Investigator leads investigations into fraud, waste, and abuse within healthcare programs, owning cases from intake through resolution. The role analyzes provider and member data, develops investigative plans, and presents findings to internal stakeholders and external agencies. The investigator also serves as a subject-matter resource on fraud prevention and cost-containment initiatives.
Required Skills
- Fraud Investigations
- Data Analysis
- Case Management
- Interviewing
- Report Writing
- Audit Sampling
- Medical Coding
- Legal Coordination
- Microsoft Excel
- Communication
Qualifications
- Bachelor's Degree
- Combination of Education and Work Experience
- AHFI - Accredited Healthcare Fraud Investigator
- CFE - Certified Fraud Examiner
- CPC - Certified Professional Coder
- LSSBB - Lean Six Sigma Black Belt
- RN - Registered Nurse
- State RN Licensure
About Magellan Health
magellanhealth.comMagellan Health manages the fastest growing, most complex areas of healthcare, bringing solutions to health plans, employers and state and Federal programs.
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