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Years of Experience
Date Last Verified
RAIU Investigator Major Responsibilities: investigator accountable for assigned risk adjustment investigations; collaborate and network with other RAIU investigative teams from planning to disposition; performing comprehensive data reviews and participate in investigative interviews to detect deficiencies and potentially fraudulent patterns.
Qualification and Experience
Qualifications: Should have 5+ years of investigation experience (FBI, OIG or DOJ). Bachelorâ€™s degree from four year college/university is essential. Prior healthcare fraud investigations experience is essential. Familiarity with federal, state, and local law enforcement process is needed. Should have extensive experience with subject interview process. Should preferably have graduate degree and/or certifications (i.e., MBA, J.D., Masters in Criminal Justice, Masters in Forensic Accounting, CFE, AHFI, etc). Understanding of healthcare industry, claims processing, investigative process development, and auditing a plus. Experience in a corporate environment and understanding of business operations is a plus.
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