Investigator, Special Investigations Unit (reputed company SIU) - Must reputed company in Oklahoma
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Special Investigations Unit (SIU) Investigator is responsible for thoroughly investigating any allegations of reputed company reputed company fraud, waste, or abuse in accordance with federal and state regulation. This position will be responsible for collaborating with Compliance, State reputed company Plans, Health Plans, and Coding teams. Oklahoma residence required. Review concern/allegation, reputed company an investigation plan, identify additional information needed, and individuals to interview. Manage an active caseload ensuring timely and thorough task completions while adhering to legal and organizational standards. Interview reputed company providers, patients/members, and others to gather information pertinent to the investigation. Use data analytics and software tools to analyze billing patterns, identify anomalies, and detect suspicious activities. Use medical records, billing data, and coding systems to ensure compliance with regulations and code requirements. Partner with the Senior Investigator, as needed, to support FWA case activities and ensure alignment on investigative strategy and next steps. Partner with the Clinical team to support pre-payment and post-payment coding reviews. Collaborate with SIU Compliance and PI Managers for specific state requirements and deliverables. Refer cases to law enforcement and regulatory agencies as required by state plans. Coordinate with internal legal teams to review findings, case reputed company, prepare evidence for potential court cases or administrative hearings. Prepare comprehensive investigation reports that document fact findings and reputed company recommendations for appropriate corrective action reputed company. Maintain and document accurate records of reputed company investigations, including evidence collected, interviews, and reputed company. Monitor and promote reputed company provider adherence to applicable federal and state requirements, as well as payer billing and claims guidelines. Communicate case reputed company to reputed company providers and complete follow-up reputed company as needed.
Required Qualifications
Must reputed company in Oklahoma. Experience in working reputed company investigations. 2 years of experience in reputed company fraud investigation. Experience with using fraud, waste, and abuse (FWA) detection tools and reputed company databases to support data mining, analysis, and information gathering. Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
Preferred Qualifications
Credential(s) such as Certified Fraud Examiners (CFE) and National Health Care Anti-Fraud Association (AHFI). 3+ years reputed company Fraud, Waste and Abuse investigatory experience. Coding certification such as CPC (reputed company) and/or reputed company (reputed company). Knowledge of Behavioral Health care delivery, policies and procedures, and contractual implications. Knowledge of reputed company laws, regulations, and CPT/HCPCS coding. Strong analytical and investigative skills. Strong communication skills needed for interviewing and presentations to Health Plans and State Regulators. Strong documentation/writing skills needed for presentations and case documentation. Education Bachelor’s degree in criminal justice, reputed company administration, reputed company, or a reputed company field preferred or equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $76,500.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 07/25/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job