Lead Fraud Investigator
About The Position
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. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary BASIC FUNCTION HCSC is looking for a dynamic individual to join its Fraud Investigations team! This position will be responsible for identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and the misuse of claims, billing, or improper payments. May also be responsible for establishing and maintaining close liaison (as indicated in plan design) with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Will be reviewing transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testifying in court. Incumbent conducts complex, large-scale investigations and mentor junior-level investigators. expertise in data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills NOTE: this role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days. Relocation is NOT offered; sponsorship will NOT be extended either now or in the future. #LI-TP1 #LI-hybrid
Requirements
- Bachelor’s Degree.
- Seven (7) years’ fraud investigative experience OR 7 years of direct law enforcement experience (local, state, or federal).
- Experience directing complex fraud investigations which result in criminal or civil prosecutions.
- Aptitude with planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations.
- Familiarity with state and federal laws apps.
- Expertise in data analysis tools, investigative proficiency, and strong communication skills.
- Proficiency with MS Office (Word, Excel, PowerPoint) as well as Workday.
Nice To Haves
- Certified Professional Coder (CPC).
- Certified Fraud Examiner (CFE).
- Accredited Health Care Fraud Investigator.
- Exceptional ability to identify fraud, waste and abuse trends and work with advanced analytics in identifying emerging schemes and trends.
Responsibilities
- identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and the misuse of claims, billing, or improper payments
- establishing and maintaining close liaison (as indicated in plan design) with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases
- reviewing transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testifying in court
- conducts complex, large-scale investigations and mentor junior-level investigators
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
- annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
