Remote Fraud & Abuse Investigator (CPC/CFE)

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

Benefits offered by this job

Adoption/Surrogacy Reimbursement up to

Disability Insurance (Long-Term)

Disability Insurance (Short-Term)

Critical Illness Coverage

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Job summary

Sentara Health Plans seeks an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time role. The position offers travel to Virginia Beach 1x per year and supports analysis across provider, pharmacy, and claims data to ensure compliant reimbursement.

The candidate will review coding quality, participate in audits, triage leads, and conduct research to identify and address potential fraud, waste, and abuse.

Qualifications

• Bachelor's Degree
• Minimum of 2 years combined experience required in Medical Coding OR Healthcare (Medical Chart Review/Insurance Billing) OR Internal/External Audit OR Regulatory/Compliance OR Claims Investigations OR Criminal Investigation/White Collar Crime
• Certified Fraud Examiner (CFE) OR Accredited Health Care Fraud Investigator (AHFI)
• Professional Writing, Verbal Communication, Time Management, Complex Problem Solving/Critical Thinking, Microsoft Excel and Word, Microsoft Access and Outlook

Responsibilities

• Assist in the investigation of potential fraud, waste, and abuse.
• Conduct research in support of an investigation.
• Collect and evaluate potential suspicious patterns in claims data, provider enrollment data, and other sources and refers to Investigator for investigation or settlement.
• Assures accurate reimbursement is obtained and coding practices are compliant.
• Participates in special projects as required.

Skills

Professional Writing

Verbal Communication

Time Management

Complex Problem Solving

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Education

Bachelor's Degree

Job description

Sentara Health Plans seeks an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time role. The position offers travel to Virginia Beach 1x per year and supports analysis across provider, pharmacy, and claims data to ensure compliant reimbursement.

The candidate will review coding quality, participate in audits, triage leads, and conduct research to identify and address potential fraud, waste, and abuse.