Healthcare Investigations Analyst I – Fraud & Abuse

THPP Tufts Health Public Plans Inc; Rhode Island; Hybrid; USD 67,000 - 100,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Retirement plans

Paid time off

Tuition program

Well-being benefits

Job summary

Point32Health is hiring an Investigator I for the Special Investigations Unit to lead provider investigations related to fraud, waste and abuse. You will apply laws, plan policies, review data and medical records, and prepare detailed reports.

Minimum bachelor’s degree and 1–3 years in health insurance fraud investigations; CPC or CFE preferred. You’ll work from home as needed, with occasional on-site meetings and a collaborative, fast-paced team environment.

Qualifications

• Certification and Licensure: CPC; CFE designation a plus.
• Education Required: Bachelor’s degree.
• Experience Required: 1-3 years’ related experience in health insurance fraud investigations.
• Skill Requirements: Clear, concise, well-organized documents; resilient, collaborative, flexible, innovative.

Responsibilities

• Lead straightforward and moderately complex investigations in fraud, waste and abuse.
• Conduct internal and external research, review data analyses, medical records, and interviews.
• Apply laws, plan policies, contract provisions, coding and coverage rules to investigation info.
• Complete detailed reports and notices for providers or entities.

Skills

CPC

CFE

Clear writing

Collaboration

Flexibility

Education

Bachelor's degree

Job description

Point32Health is hiring an Investigator I for the Special Investigations Unit to lead provider investigations related to fraud, waste and abuse. You will apply laws, plan policies, review data and medical records, and prepare detailed reports.

Minimum bachelor’s degree and 1–3 years in health insurance fraud investigations; CPC or CFE preferred. You’ll work from home as needed, with occasional on-site meetings and a collaborative, fast-paced team environment.