Remote Investigator II: Fraud, Waste & Abuse Analytics

P32HS Point32Health Services Inc; Massachusetts; Hybrid; USD 81,000 - 121,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Career development opportunities

Job summary

Point32Health is seeking an Investigator II to lead complex provider investigations related to fraud, waste, and abuse within the SIU. You will set investigative priorities, develop strategies, and collaborate with cross-functional teams to address findings and prevent losses.

The role requires 3–5 years in health insurance investigations, CPC certification (CFE a plus), and a Bachelor’s degree. It offers a hybrid work arrangement with a comprehensive total rewards package including medical,

Qualifications

• Certification and Licensure: CPC; CFE designation a plus.
• Education: Bachelor's degree required.
• Experience: 3–5 years in health insurance and/or fraud investigations.
• Preferred: Experience drafting and distributing summary findings notices.

Responsibilities

• Lead moderately complex to complex investigations in FWA areas.
• Apply laws, plan policies, contract provisions, coding rules and industry standards to investigations.
• Complete detailed reports and summary findings notices for providers.
• Educate providers, recover overpayments, and monitor activity post-investigation.
• Identify root causes and recommend corrective actions to address FWA.

Skills

CPC Certification

CFE designation

Clear written communication

Collaborative

Flexible

Innovative

Education

Bachelor's degree

Job description

Point32Health is seeking an Investigator II to lead complex provider investigations related to fraud, waste, and abuse within the SIU. You will set investigative priorities, develop strategies, and collaborate with cross-functional teams to address findings and prevent losses.

The role requires 3–5 years in health insurance investigations, CPC certification (CFE a plus), and a Bachelor’s degree. It offers a hybrid work arrangement with a comprehensive total rewards package including medical,