Remote Fraud & Abuse Investigator (CPC)

Sentara Health; Nebraska; Remote; USD 44,000 - 63,000; Full time

Benefits offered by this job

Bonus opportunities

Medical, dental, vision insurance

Paid time off

Job summary

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position supports deep investigations into fraud and abuse across provider and claims data, with on-site travel to Virginia Beach once yearly.

The role requires a Bachelor's degree and at least 2 years in medical coding, healthcare auditing, or related fields, plus a CFE or AHFI certification. Strong writing, communication, and MS Office skills are essential.

Qualifications

• Bachelor's Degree required with 2+ years in Medical Coding, Healthcare, or related audits.
• CFE or AHFI certification required or in progress.
• Strong writing, communication, time management, and analytical skills; proficiency with MS Office.

Responsibilities

• Contribute to in-depth investigations for suspected fraud or abuse across providers, pharmacy, and claims.
• Review coding in desk audits and on-site audits to ensure accuracy and compliance.
• Be involved in reviews of reimbursement systems and claims processing policies.
• Triage and prioritize leads and member complaints; conduct research to support investigations.
• Assist in collecting and evaluating suspicious patterns in claims data and enrollment data.
• Participate in special projects as required.

Skills

Professional Writing

Verbal Communication

Time Management

Complex Problem Solving

Critical Thinking

Microsoft Excel

Microsoft Word

Microsoft Access

Microsoft Outlook

Education

Bachelor's Degree

Certified Fraud Examiner (CFE)

Accredited Health Care Fraud Investigator (AHFI)

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Microsoft Outlook

Job description

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position supports deep investigations into fraud and abuse across provider and claims data, with on-site travel to Virginia Beach once yearly.

The role requires a Bachelor's degree and at least 2 years in medical coding, healthcare auditing, or related fields, plus a CFE or AHFI certification. Strong writing, communication, and MS Office skills are essential.