Remote Fraud & Abuse Investigator — CPC Certified

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

Benefits offered by this job

Discretionary bonus potential

Comprehensive benefits package

Life and disability insurance

Adoption, Fertility, Surrogacy support

Job summary

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position supports investigations across fraud and coding quality with periodic travel to Virginia Beach.

The candidate will review claims, coding, and reimbursement processes, triage leads, and contribute to special projects. A Bachelor's degree and relevant experience are required, with CFE/AHFI preferred.

Qualifications

• Bachelor's degree required.
• Minimum 2 years combined experience in medical coding, healthcare, audits, compliance or investigations.
• Certification: CFE or AHFI preferred.

Responsibilities

• Contribute to in-depth investigations for suspected fraud or abuse across providers, pharmacy, employer, member, and broker interactions.
• Review coding quality in desk audits and on-site audits.
• Review reimbursement systems and ensure policy adherence.
• Triage and prioritize leads and complaints from internal sources.
• Assist investigations, conduct research, and evaluate potential patterns in data.

Skills

Professional Writing

Verbal Communication

Time Management

Critical Thinking

Complex Problem Solving

Education

Bachelor's Degree

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

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 investigations across fraud and coding quality with periodic travel to Virginia Beach.

The candidate will review claims, coding, and reimbursement processes, triage leads, and contribute to special projects. A Bachelor's degree and relevant experience are required, with CFE/AHFI preferred.