Senior Fraud Investigator & Program Lead

Highmark Health; Des Moines (IA); On-site; USD 79,000 - 127,000; Full time

Job summary

Highmark Inc. is seeking an experienced investigator to develop and maintain an anti-fraud program, lead investigations into fraud, waste and abuse, and coordinate with law enforcement and regulatory agencies. The role includes training delivery and reporting under state regulations.

The position requires a strong background in health insurance fraud investigations, excellent communication, and the ability to testify in court when necessary. Office-based with potential field work.

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, Nursing, IT or related field.
• 6 years of related and progressive experience in lieu of Bachelor's degree
• Preference for Master’s Degree in Fraud, Forensics Accounting, Business or related field

Responsibilities

• Coordinate investigative activities for the team and serve as initial point of contact for internal/external members.
• Lead investigations into potential fraud, waste and abuse and conduct interviews as needed.
• Develop and maintain annual anti-fraud program including training and annual fraud plans/reports.

Skills

Investigations

Interviews

Fraud awareness

Data mining tools

Communication

Regulatory compliance

Education

Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field

Tools

Fraud data mining tools

Job description

Highmark Inc. is seeking an experienced investigator to develop and maintain an anti-fraud program, lead investigations into fraud, waste and abuse, and coordinate with law enforcement and regulatory agencies. The role includes training delivery and reporting under state regulations.

The position requires a strong background in health insurance fraud investigations, excellent communication, and the ability to testify in court when necessary. Office-based with potential field work.