Healthcare Fraud Investigator - Case Development- Remote
About This Gig
Join a specialized Special Investigations (SIU) referral and case enhancement team focused on identifying and mitigating healthcare fraud. In this role, you’ll use your investigative experience and data‑driven insights to assess suspected fraud referrals, uncover high‑risk billing patterns, and guide meaningful investigations that protect patients and reduce financial risk for clients and customers. Responsibilities: Independently research, analyze, and assess suspected healthcare fraud referrals using investigative techniques and data analysis. Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review. Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation. Deliver clear, well‑structured case assessments with actionable investigative recommendations. Partner closely with investigators and field staff to develop leads and refine investigative strategies. Use technology and analytics to support
Skills & Tags
About the Seller
The Cigna Group
on Himalayas