Healthcare Fraud Investigator-Remote

About the position Healthcare Fraud Investigator: Make an impact protecting customers, data, and healthcare integrity. We’re looking for a skilled and motivated Healthcare Fraud Investigator to handle complex healthcare fraud matters that impact our customers and the organization. In this role, you’ll take ownership of investigations from start to finish—using sound judgment, analytic thinking, and collaboration to bring cases to resolution. This is an opportunity for investigators who enjoy digging into details, following the data, and working on high‑value cases that truly matter.

Responsibilities

• Lead in‑depth investigations into suspected or confirmed healthcare fraud, using a thoughtful and independent investigative approach.
• Gather, analyze, and synthesize information from a variety of sources, including claims data, records, interviews, and internal partners.
• Manage complex, high‑dollar investigations with a high degree of autonomy.
• Prepare clear, well‑documented investigative reports and evidence packages to support case resolution, recovery efforts, or external referrals.
• Coordinate with internal stakeholders and, when appropriate, local, state, or federal agencies to support investigations.
• Respond to subpoenas or regulatory inquiries and provide testimony when required, in partnership with legal and compliance teams.
• Support special projects related to fraud detection, auditing, and continuous improvement of investigative practices.
• Protect sensitive customer and company information, including PHI, while maintaining strict confidentiality standards.

Requirements

• Bachelor’s degree in Criminal Justice or 7+ years of investigative claims experience
• 3+ years of healthcare fraud investigation, SIU, audit, payment integrity, or related experience.
• Proven ability to manage complex investigations independently and bring them to resolution.
• Strong analytical and computer skills, with proficiency in Microsoft Excel, Word, and similar tools.
• Excellent written and verbal communication skills, including the ability to present findings clearly and professionally.
• Comfort working with sensitive, confidential information and exercising sound judgment.
• Ability to adapt to changing priorities and work effectively in a fast‑paced environment.
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Benefits

• Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, 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.