Fraud Investigator - Data Analysis & Recovery

Taleo; New York (NY); On-site; USD 65,000 - 105,000; Full time

Job summary

Taleo in New York is seeking an experienced investigator to manage fraud and abuse cases, operate the hotline, and entry into the department’s case tracking system.

You will conduct confidential investigations, analyze medical records for billing accuracy, prepare case files and reports, and coordinate with vendors for anti-fraud services.

Travel is required; strong analytical, communication, and organizational skills are essential.

Qualifications

• Minimum two years of fraud investigations experience or equivalent education/training.
• Experience with ERISA/ Taft-Hartley plans is preferred but not required.
• Proven ability to prepare and maintain investigative case files with reports and evidence indexing.
• Strong confidentiality, organizational, and time-management skills.
• Proficiency in Microsoft Office and case-tracking software.

Responsibilities

• Operate the Fraud & Abuse hotline and log complaints.
• Conduct confidential investigations and collect supporting evidence.
• Analyze medical records to assess billing and reimbursement.
• Prepare case files, reports, and index evidence.
• Participate in meetings involving case strategy and negotiations.
• Pursue recovery of overpayments and manage settlement actions.
• Produce Monthly Management and Recovery reports.
• Research to develop supporting evidence.
• Conduct interviews with providers, members, and witnesses.
• Coordinate outsourced anti-fraud services with external vendors.
• Develop communications with providers and vendors.
• Attend training to maintain industry knowledge.
• Perform special projects as directed.

Skills

Analytical thinking

Investigation skills

Confidentiality

Interpersonal communication

Project management

Data analysis

Education

Bachelor's Degree in Criminal Justice or related field

Tools

Microsoft Office

Case tracking software

Job description

Taleo in New York is seeking an experienced investigator to manage fraud and abuse cases, operate the hotline, and entry into the department’s case tracking system.

You will conduct confidential investigations, analyze medical records for billing accuracy, prepare case files and reports, and coordinate with vendors for anti-fraud services.

Travel is required; strong analytical, communication, and organizational skills are essential.