Lead Fraud & FWA Investigator - Remote

Point32Health, Inc.; United States; Hybrid; USD 81,000 - 121,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Career development support

Job summary

Point32Health is seeking an Investigator II in the Special Investigation Unit to lead complex provider investigations related to fraud, waste and abuse, and to develop action plans to address findings and prevent loss.

The role requires applying laws and plan policies, producing detailed reports, educating providers, recovering overpayments, and identifying root causes to improve processes. The position may require travel and collaboration with cross-functional teams.

Qualifications

• Bachelor’s degree required; clinical/scientific, business, accounting, CS or criminal justice preferred.
• CPC certification or CFE designation a plus.
• 3-5 years’ experience in health insurance or fraud investigations.

Responsibilities

• Lead moderately to complex investigations of fraud, waste and abuse with data analyses and interviews.
• Apply laws, policies, coding rules and industry standards to investigation data.
• Prepare detailed reports and summary findings notices for providers or entities.
• Educate providers, recover overpayments, and monitor activity post-investigation.
• Identify root causes and recommend corrective actions.

Skills

Clear writing

Collaboration

Flexibility

Innovative

Education

Bachelor’s degree

CPC Certification

CFE designation

Job description

Point32Health is seeking an Investigator II in the Special Investigation Unit to lead complex provider investigations related to fraud, waste and abuse, and to develop action plans to address findings and prevent loss.

The role requires applying laws and plan policies, producing detailed reports, educating providers, recovering overpayments, and identifying root causes to improve processes. The position may require travel and collaboration with cross-functional teams.