Healthcare Investigator-Fraud Lead Analyst-Remote
About the position The Fraud Investigator leads in-depth investigations into suspected or confirmed fraud impacting our customers or the company. Using strong judgment and independence, this role identifies the right investigative approach, gathers and analyzes critical information, and drives cases toward resolution and potential restitution. You’ll prepare clear investigative reports, build evidence packages for external partners, and collaborate closely with state and federal agencies. You may also respond to subpoenas and represent the company in legal proceedings. This role requires protecting customer PHI while managing sensitive, high‑value cases.
Responsibilities
- Conduct interviews, research, and analysis to resolve fraud allegations.
- Manage complex, high-dollar investigations with minimal supervision.
- Prepare detailed reports and evidence packages for insurance fraud bureaus, contract holders, and law enforcement.
- Coordinate investigations with local, state, and federal agencies.
- Respond to subpoenas and regulatory requests; provide testimony when needed.
- Support special projects involving fraud detection, auditing, and investigative best practices.
- Partner with internal departments while maintaining strict confidentiality standards.
Requirements
- Bachelor’s degree in Criminal Justice or related field or 7+ years of investigative claims experience.
- 3+ years of health insurance investigation or audit experience strongly preferred.
- Strong computer and analytical skills; proficiency in careerzynith Excel, Access, and Word preferred.
- Excellent written and verbal communication skills.
- Ability to adapt quickly to changing priorities and work independently.
- 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. apply to this job