Senior SIU Investigator: Fraud, Waste & Abuse

Texas Children's Hospital; Bellaire (TX); On-site; USD 90,000 - 130,000; Full time

Job summary

Texas Children’s Health Plan is seeking a Senior SIU Investigator to assist the Director of Controls and Compliance in conducting investigations into suspected Fraud, Waste, and Abuse. You will mine data for potential intakes, perform preliminary analysis on provider cases, and contribute to projects aimed at preventing, detecting, and correcting FWA.

The role requires strong investigative skills, adherence to procedures, and the ability to collaborate with federal and state agencies.

Qualifications

• High School Diploma or GED required; Bachelor’s degree preferred.
• 6 years’ experience in claims examination, adjusting, fraud detection, or investigations, preferably healthcare.
• AHFI certification by NHCAA preferred.

Responsibilities

• Conducts Fraud, Waste and Abuse (FWA) and related compliance investigations.
• Completes detailed investigations and gathers evidence for potential recoveries.
• Develops investigation strategy and leads in-depth interviews with participants and witnesses.
• Prepares cases for clinical and legal reviews and identifies payment accuracy improvements.
• Analyzes FWA cases for root cause and trends to drive process improvements.
• Produces accurate, timely written reports and case summaries per SOPs.

Skills

Investigative analysis

Data mining

Interviews & evidence gathering

FWA investigations

Education

High School Diploma or GED

Bachelor's degree preferred

AHFI certification (preferred)

Job description

Texas Children’s Health Plan is seeking a Senior SIU Investigator to assist the Director of Controls and Compliance in conducting investigations into suspected Fraud, Waste, and Abuse. You will mine data for potential intakes, perform preliminary analysis on provider cases, and contribute to projects aimed at preventing, detecting, and correcting FWA.

The role requires strong investigative skills, adherence to procedures, and the ability to collaborate with federal and state agencies.