Healthcare FWA Investigator

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 70,000 - 100,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island seeks an Investigative Auditor to manage intake, triage, review, and documentation of FWA referrals. This role conducts audits, analyzes claims data, and reports findings to ensure compliance with federal and state guidelines.

Responsibilities include coordinating with external agencies, preparing data requests, and developing corrective action plans while maintaining documentation integrity. Strong analytical and communication skills are essential.

Qualifications

• Associate degree in a health-related field with 2+ years in healthcare FWA investigations or audits.
• Proven ability to analyze data, identify risk, and remain objective in investigations.
• Strong oral and written communication; ability to present findings clearly.

Responsibilities

• Respond to FWA allegations with intake, triage, and full investigations.
• Analyze enrollment data, contracts, and claims history to identify FWA patterns.
• Perform data analysis and reviews of claims data to detect trends and issues in healthcare fraud.

Skills

Investigatory skills

Analytical thinking

Communication skills

MS Office proficiency

Education

Associate degree in health information management/related field

Bachelor’s degree (preferred)

Tools

Microsoft Office

SharePoint

Job description

Neighborhood Health Plan of Rhode Island seeks an Investigative Auditor to manage intake, triage, review, and documentation of FWA referrals. This role conducts audits, analyzes claims data, and reports findings to ensure compliance with federal and state guidelines.

Responsibilities include coordinating with external agencies, preparing data requests, and developing corrective action plans while maintaining documentation integrity. Strong analytical and communication skills are essential.