Senior Fraud Investigator & Program Lead

Highmark Health; Boise (ID); On-site; USD 73,000 - 117,000; Full time

Job summary

Highmark Inc. seeks a skilled investigator to develop and maintain an anti-fraud program, conduct investigations of fraud, waste and abuse across providers, members and facilities, and coordinate with law enforcement as needed. The role involves field investigations, data analysis, and training colleagues.

The incumbent will testify in court, prepare cases for referral, and help ensure regulatory compliance through audits and reporting.

Qualifications

• Bachelor's degree or 6 years of related experience in accounting, finance, business or IT.
• Experience in health insurance or healthcare fraud investigations preferred.
• Masters in fraud/forensics is a plus.

Responsibilities

• Investigate potential and existing fraud, waste and abuse activities.
• Interview providers and members as needed.
• Coordinate data extracts from multiple databases.
• Develop and maintain anti-fraud program and training.

Skills

Investigation skills

Data mining tools

Communication skills

Team leadership

Problem solving

Court testimony

Auditing

Education

Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or related field

6 years of related experience in lieu of Bachelor's degree

Master's degree in Fraud/Forensics/Business

Tools

Fraud data mining tools

Job description

Highmark Inc. seeks a skilled investigator to develop and maintain an anti-fraud program, conduct investigations of fraud, waste and abuse across providers, members and facilities, and coordinate with law enforcement as needed. The role involves field investigations, data analysis, and training colleagues.

The incumbent will testify in court, prepare cases for referral, and help ensure regulatory compliance through audits and reporting.