Remote Fraud & Abuse Investigator (CPC/CFE)

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

Benefits offered by this job

Adoption, Fertility and Surrogacy Reim

Long-Term/Short-Term Disability

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Job summary

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work for eligible U.S. states, with occasional Virginia Beach travel.

The role focuses on deep investigations across provider, pharmacy, and claims data, ensuring compliant coding and proper reimbursement. A Bachelor's degree and at least 2 years in related healthcare fields are required; CFE or AHFI certification is preferred.

Qualifications

• Bachelor's Degree required.
• Minimum 2 years combined experience in Medical Coding or related healthcare fields.
• Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred.
• Strong writing, communication, time management and analytical skills.
• Proficiency with Microsoft Office applications.

Responsibilities

• Assist in investigations of suspected fraud, waste and abuse.
• Research and collect data to support investigations and referrals.
• Analyze claims data and provider enrollment data for suspicious patterns.
• Ensure accurate reimbursement and compliant coding practices.
• Participate in special projects as needed.

Skills

Verbal Communication

Professional Writing

Time Management

Complex Problem Solving

Education

Bachelor's Degree

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Microsoft Outlook

Job description

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work for eligible U.S. states, with occasional Virginia Beach travel.

The role focuses on deep investigations across provider, pharmacy, and claims data, ensuring compliant coding and proper reimbursement. A Bachelor's degree and at least 2 years in related healthcare fields are required; CFE or AHFI certification is preferred.