Healthcare SIU Investigator - Ogden Utah

Company: VirtualVocations
Location: Ogden, Utah
Posted On: 01/29/2025

A company is looking for a SIU Investigator (Healthcare) to join their team.



Key Responsibilities

Identify and conduct investigations into known or suspected fraud, waste, and abuse (FWA)
Develop documentation to substantiate findings, including reports and audit logs
Meet targets for FWA recoupments and savings through investigations and process improvements


Required Qualifications

3+ years of insurance claims investigation experience or professional investigation experience with law enforcement
1+ year experience with fraud statutes and regulations, and federal guidelines on recoupments
Bachelor's degree in Criminal Justice or a related field (preferred)
Experience working in health insurance, specifically with claims processing or provider contracting (preferred)
Relevant certifications such as Certified Fraud Examiner (CFE) or Certified Professional Coder (CPC) (preferred) More...

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