Job Title: Investigator Senior
Job Responsibilities:
The Investigator Senior is responsible for the independent identification, investigation, and development of complex cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. The role involves reviewing claims for appropriate coding, data mining, entity review, law enforcement referral, and utilizing proprietary data and claim systems for the review of facility, professional, and pharmacy claims. The position requires the individual to independently identify and develop enterprise-wide specific healthcare investigations and initiatives that may impact multiple company health plans, lines of business, and/or states. The Investigator Senior may interface internally with senior-level management and the legal department throughout the investigative process and may assist in the training of internal and external entities. Additionally, the role involves assisting in the development of policies and/or procedures to prevent the loss of company assets and may require representing the company in court proceedings regarding research findings. The position also necessitates developing and maintaining a high degree of rapport and cooperation with federal, state, and local law enforcement and regulatory agencies to assist in investigative efforts.
Education and Experience Information:
The position requires a BA/BS degree and a minimum of 5 years of related experience in healthcare insurance, healthcare insurance investigation, or law enforcement. Alternatively, any combination of education and experience that provides an equivalent background is acceptable. Preferred qualifications include professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designations. Knowledge of plan policies and procedures in all facets of benefit programs management with a heavy emphasis on negotiation is also preferred.
Salary Information:
For candidates working in person or virtually in specific locations such as California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, New York, and Washington State, the salary range for this position is $78,400 to $141,120. In addition to the salary, the company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions, subject to eligibility requirements. The salary offered is based on several legitimate, non-discriminatory factors set by the company, which is committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range the company believes is possible compensation for this role at the time of posting, and it may be modified in the future. Actual compensation may vary based on geographic location, work experience, education, and skill level. The company retains discretion over the amount and availability of any bonus, commission, benefits, or other forms of compensation and benefits, which may be modified at its sole discretion, consistent with the law.
