Sr Fraud Investigator

Health Care Service Corporation; Chicago (IL); Hybrid; USD 54,000 - 122,000; Full time

Job summary

A leading health care organization is seeking a Sr Fraud Investigator to enhance their fraud prevention efforts. This role involves developing investigation tools, conducting thorough investigations into fraudulent claims, and recommending improvements to operational controls. The ideal candidate will possess a Bachelor's degree and relevant experience in law enforcement or health care fraud investigations, along with strong communication skills.

Qualifications

• 5 years law enforcement experience or 3 years health care fraud investigative experience.
• Familiarity with laws applicable to health care fraud.
• Ability to independently prepare reports accurately.

Responsibilities

• Plan and develop investigation tools and techniques.
• Conduct detailed investigations of potentially fraudulent claim activity.
• Review operational controls and recommend enhancements.

Skills

Communication

Investigation

Liaison Relations

Education

Bachelor’s Degree

Tools

Excel

PowerPoint

Word

Outlook

Job description

Join to apply for the Sr Fraud Investigator role at Health Care Service Corporation

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees, and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery, and litigation. Additionally, reviews operational controls, claim system controls, and protocols, and recommends enhancements to reduce the potential for fraud.

Job Requirements

• Bachelor’s Degree
• 5 years law enforcement experience (local, state, or federal) OR 3 years health care fraud investigative experience.
• Familiarity with laws applicable to health care fraud.
• Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
• Ability to independently prepare reports of interviews and other documentation accurately reflecting investigative activity and results.
• Clear and concise verbal and written communication skills.

Preferred Requirements

• Knowledge of Medicare
• Accredited Health Care Fraud Investigator
• Certified Professional Coder
• Certified Fraud Examiner
• Knowledge of health care claims processing and benefit administration.
• Experience working with Excel, PowerPoint, Word, and Outlook.

Please note that this role is HYBRID with an in-office requirement of 3 days a week.

Compensation: $54,800.00 - $121,100.00. Exact compensation may vary based on skills, experience, and location.

Employment Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Legal
• Industries: Hospitals and Health Care

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click here.