Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
Support on-site inspections and patient/provider interviews as necessary
Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance
May represent the company as a witness in judicial proceedings when appropriate
Prepare reports to expedite tracking and reporting of investigations

Bilingual Spanish and ability to pass oral and written assessments
A bachelor’s degree in Criminal Justice or related field
1+ years professional work experience, preferably with health insurance investigations/audit
Outstanding technical & analytical skills, with particular proficiency with Access, Excel and Word
Excellent verbal and written communication skills, along with ability to effectively manage conflict
Keen ability to deal with ambiguity and leverage reasoning skills
Possession of a strong desire and demonstrated ability to lead

Bilingual Junior Healthcare Fraud Investigator

Key skills