Auditor​/Investigator II

Conduct routine and impartial audits/investigations from start to closure into customer claims
Ensure accurate and fair assessments of claims validity
Address customer inquiries and concerns and escalated audits/investigations as needed
Compile detailed records of audit/investigation findings in compliance with legal and regulatory requirements
Create and implement strategies to identify and prevent fraudulent activities
Conduct interviews with witnesses, claimants, and other stakeholders
Communicate with internal teams to ensure proper processing of audits/investigations
Communicate findings clearly and professionally and provide updates
Assist with training and support for other auditors/investigators
Plan and arrange own work while working with a manager to prioritize projects

• Minimum Bachelor's Degree required; education can be substituted for experience
• 2–4 years of experience required; 5–7 years preferred
• Healthcare fraud experience desired
• Knowledge of Medicare preferred
• Certified Fraud Examiner certification preferred
• Successful completion of pre-employment background and drug screens
• Ability to conduct audits/investigations, review claims documentation, analyze data, interview stakeholders, and prepare reports
• Ability to communicate with customers, claimants, stakeholders, and internal teams while adhering to legal and regulatory standards

Demonstrates expertise in conducting audits and investigations, ensuring compliance with legal and regulatory standards while effectively communicating findings. Proficient in analyzing claims documentation and implementing strategies to prevent fraudulent activities.

• Conducting Audits/Investigations
• Healthcare Fraud Experience
• Certified Fraud Examiner
• Claims Documentation Review
• Data Analysis

• Audit Conducting
• Investigation Techniques
• Claims Analysis
• Report Preparation
• Data Analysis

• Effective Communication
• Customer Service
• Problem Solving
• Team Collaboration
• Training and Support

• Certified Fraud Examiner

• Healthcare Fraud
• Medicare
• Legal Compliance
• Regulatory Standards
• Fraud Prevention Strategies