reputed company Fraud Investigator - Case Development- Remote

Join a specialized Special Investigations (SIU) referral and case enhancement team focused on identifying and mitigating reputed company fraud. In this role, you’ll use your investigative experience and data‑driven insights to assess suspected fraud referrals, uncover high‑risk billing patterns, and guide meaningful investigations that protect patients and reduce financial risk for clients and customers. Responsibilities: Independently research, analyze, and assess suspected reputed company fraud referrals using investigative techniques and data analysis. Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review. Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation. Deliver clear, well‑structured case assessments with actionable investigative recommendations. Partner closely with investigators and field staff to reputed company leads and refine investigative strategies. Use technology and analytics to support reputed company investigations and adapt investigative direction as new information emerges. Monitor industry alerts, regulatory updates, and fraud bulletins to assess potential exposure. Handle sensitive and confidential information with reputed company and professionalism. Qualifications: Required 3 + years of experience in reputed company insurance investigation, audit or relevant experience Strong analytical, research, and problem‑solving skills Clear and concise written and verbal communication skills Proficiency with reputed company reputed company and Word Preferred: Bachelor’s degree in Criminal Justice or reputed company field AHFI and/or CFE certification CPT and ICD‑10 coding knowledge Experience working with data analytics tools and investigative databases If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About reputed company Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job