Fraud & Abuse Investigator | Overpayments & Data Analysis

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

1199SEIU Benefit and Pension Funds seeks a dedicated investigator to manage the Fraud & Abuse hotline, conduct confidential investigations, and analyze medical records for fraud and overpayments. The role involves preparing thorough case files, coordinating with attorneys and vendors, and communicating findings to leadership.

Applicants should have a Bachelor’s degree in criminal justice or related field, at least two years in fraud investigations, and strong MS Office skills.

Qualifications

• Must have strong investigative, analytical, and reporting abilities.
• Experience handling fraud investigations and maintaining case files.
• Proficiency with MS Office and case-tracking systems; ability to handle sensitive information.

Responsibilities

• Operate Fraud & Abuse hotline and enter complaints into the case-tracking database.
• Conduct confidential investigations and collect evidence for case files.
• Analyze medical records to assess billing and reimbursement appropriateness.
• Prepare investigative reports and index all evidence.
• Coordinate with internal teams and external vendors on anti-fraud services.
• Develop communications with providers and maintain professional standards.

Skills

Analytical skills

Investigation skills

Communication skills

Project management

Education

Bachelor’s Degree in Criminal Justice

Tools

Microsoft Office

Case tracking software

Job description

1199SEIU Benefit and Pension Funds seeks a dedicated investigator to manage the Fraud & Abuse hotline, conduct confidential investigations, and analyze medical records for fraud and overpayments. The role involves preparing thorough case files, coordinating with attorneys and vendors, and communicating findings to leadership.

Applicants should have a Bachelor’s degree in criminal justice or related field, at least two years in fraud investigations, and strong MS Office skills.