Fraud and Waste Investigator

Become a part of our caring community The Fraud and Waste Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving South Carolina's Medicaid Program. The Fraud and Waste Professional coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Responsibilities Analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings. Assemble, organize, and analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings. Assemble, organize, and preserve evidence and supporting documentation for successful case resolution and adjudication. Communicate findings clearly and professionally, both verbally and in writing, to a variety of audiences. Conduct comprehensive investigations of reported, alleged, or suspected fraud, waste, and abuse involving the M