Healthcare Fraud Investigator — Remote & Impactful

Centene Management Company; Texas; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote, hybrid, field or office work

Job summary

Centene Management Company seeks an experienced investigator to conduct fraud, waste, and abuse (FWA) investigations in a healthcare setting in Texas. You will use referrals, claims data, and interviews to identify potential misconduct and support case resolution.

You will analyze and document investigative activities, coordinate with compliance, legal, and external agencies, and assist with audits and recovery efforts. The role requires 2+ years in relevant investigations and a related degree.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• 2+ years FWA investigations or related healthcare investigations.
• Experience analyzing healthcare claims, medical records, billing documentation, or related records.

Responsibilities

• Conducts FWA investigations using referrals, claims data, medical records, interviews, and data analytics to identify misconduct and support case resolution.
• Analyzes, documents, and maintains investigative activities, findings, and outcomes in line with procedures, regulations, and service standards.
• Reviews claims, medical records, provider billing practices, enrollment information, and financial records for potential fraud, waste, or compliance concerns.
• Prepares investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulators, or law enforcement as appropriate.
• Collaborates with compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigations and corrective actions.
• Supports audits, overpayment identification and recovery efforts, regulatory responses, and program integrity initiatives.
• Maintains compliance with applicable federal/state regulations, privacy standards, and investigative protocols.
• Monitors emerging fraud schemes and billing irregularities to identify risks and recommend actions for review.
• Supports case progression through onsite audits, visits, and witness interviews.
• Performs other duties as assigned and complies with policies.

Skills

FWA investigations

Data analytics

Interviews

Medical records review

Regulatory compliance

Audit support

Education

Bachelor's degree in related field

2+ years investigative experience

Job description

Centene Management Company seeks an experienced investigator to conduct fraud, waste, and abuse (FWA) investigations in a healthcare setting in Texas. You will use referrals, claims data, and interviews to identify potential misconduct and support case resolution.

You will analyze and document investigative activities, coordinate with compliance, legal, and external agencies, and assist with audits and recovery efforts. The role requires 2+ years in relevant investigations and a related degree.