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Senior Investigator
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Full-time
- Position Overview: The Senior Investigator manages work related to fraud, waste and abuse audits and investigations across several independent and specialized teams.
- Functions include, conducting in depth investigations making decisions and recommendations on case direction, scope and timing; collaborating with managers and staff in Claims, Provider Network, Appeals and Grievances, Finance, Utilization Management and Analytics throughout the audit lifecycle; ensuring audit compliance with state and federal laws and regulations, contract requirements and company policies and procedures as they pertain to fraud, waste and abuse.
- Utilize available Open Source Intelligence (OSINT) tools to verify provider licenses, research criminal history, disciplinary actions, financial assets and liabilities.
- Attend and participate in regional FWA Task Force and other state or federal meetings.
- Ensure regulatory reporting is developed, accurate, and submitted timely.
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