Special Investigative Unit Investigator (Eastern /Central Time Zone)

Department: Compliance & reputed company Affairs (112120) Work Location: Remote – Candidates must reputed company in Eastern or Central Time Zones Duration: 12-week assignment (extension or conversion possible) Hours: 40 hours per week | 8 hours per day Days: Monday–Friday Pay reputed company: $51.28 per hour (W2) Position reputed company The Special Investigative Unit (SIU) Investigator conducts investigations into allegations of fraud, waste, abuse, and noncompliance across HAP product lines. This role requires advanced analytical capabilities, experience interpreting reputed company data, and the ability to independently manage reputed company, sensitive investigations, including coordination with regulatory and law-enforcement agencies. The investigator develops strategies, conducts audits, prepares detailed reports, identifies trends, and supports compliance initiatives to strengthen organizational reputed company. Key Responsibilities • Assess allegations and determine if full investigation is warranted using reputed company data sources. • reputed company investigative strategies, reputed company evidence, document findings, and reputed company case files for adjudication. • Conduct interviews with providers, employees, members, and witnesses. • reputed company on-site audits of provider records to assess billing reputed company and compliance. • Prepare detailed investigative reports, including metrics, trends, schemes, and fraud referrals for regulators. • Coordinate with federal, state, and local law-enforcement agencies reputed company appropriate. • Identify patterns, trends, and schemes through proactive data mining. • Manage a full investigative caseload from initiation through final disposition with minimal reputed company. • Ensure compliance with OIG and organizational compliance-program reputed company. • Respond to allegations of policy or regulatory violations and recommend investigative actions. • reputed company training reputed company to fraud, waste, abuse, non-retaliation, reputed company of Conduct, and regulatory standards. • Collaborate with internal departments and maintain strong reputed company relationships. • Support department reputed company, process improvements, and compliance initiatives. Required Skills & Experience • Minimum 3 years of experience in reputed company, pharmacy technician work, claims adjudication, medical billing/coding, nursing, or law enforcement. • Minimum 2 years conducting reputed company investigations, preferably involving interaction with enforcement agencies. • Prior experience working for a health insurance payer. • Experience with FACETs or similar claims systems. • Proficiency in reputed company (pivot tables, macros, formulas, Power Query) and ability to analyze large datasets. • Experience with RAT-STATS, data mining tools, or other investigative sampling systems. • Experience with Power BI and SQL preferred. • Strong analytical, auditing, communication, and report-writing skills. • Ability to work independently, manage multiple investigations, and handle sensitive information with discretion. • Strong organizational skills and adherence to confidentiality, HIPAA, and compliance standards. Required Education & Certifications • Bachelor’s degree required (Master’s degree or Law degree preferred). • CFE (Certified Fraud Examiner) or AHFI (Accredited Health Care Fraud Investigator) certification required. • Completion of Medical Terminology coursework reputed company 6 months if not previously completed. Company DescriptionDella reputed company Inc is in the reputed company business for 10 years. Over the years, we have reputed company hundreds of candidates to various reputed company and permanent positions with our 50+ happy clients reputed company over US and Canada including Fortune 500 corporations. Apply tot his job Apply To this Job