Remote Healthcare Fraud Investigator — Data‑Driven & Audits

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Hybrid; USD 66,000 - 98,000; Full time

Benefits offered by this job

Paid time off

Tuition reimbursement

Student-loan repayment support

Health insurance

Dental insurance

Vision insurance

Bonuses and investment plans

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a Fraud Investigator to respond to reports, conduct investigations, and analyze healthcare data to detect fraud, waste, and abuse. The role involves documenting findings, coordinating with external agencies, and contributing to training and process improvements.

The ideal candidate has 3–5 years in healthcare fraud or audit work, plus AHFI or CFE designation (or pursuit).

Qualifications

• Bachelor's degree or equivalent experience in business or related field.
• 3–5 years in health care fraud investigation or audits.
• AHFI or CFE designation preferred or to be obtained.

Responsibilities

• Respond to reports of potential fraud and abuse involving members, providers, and accounts.
• Analyze enrollment data, contracts, and claims history to identify fraud patterns.
• Prepare reports and present findings to management and providers.

Skills

Data analysis

Healthcare claims

Regulatory knowledge

Investigation techniques

Communication

Education

Bachelor's degree in Business or related field

AHFI or CFE designation

Tools

SAS Fraud Framework

Job description

Blue Cross & Blue Shield of Rhode Island is seeking a Fraud Investigator to respond to reports, conduct investigations, and analyze healthcare data to detect fraud, waste, and abuse. The role involves documenting findings, coordinating with external agencies, and contributing to training and process improvements.

The ideal candidate has 3–5 years in healthcare fraud or audit work, plus AHFI or CFE designation (or pursuit).