Senior Investigator - Lead Validation (Healthcare FWA)

Overview As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role. This role aligns with our post-pay Fraud Waste & Abuse team. Responsibilities Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation. Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance. Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse. Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation. Conducts investigation-related training. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Maintain current knowledge of relevant laws, regulations and standards. Participates in special projects as required. Complete all responsibilities as outlined on annual Performance Plan. Complete all special projects and other duties as assigned. Must be able to perform duties with or without reasonable accommodation. This job description is intended to