Senior Investigator, Special Investigations

📋 Description

• • The Senior Investigator, Special Investigations plays a crucial role in investigating allegations of healthcare fraud, waste, and abuse to protect members and the Medicare Fund by planning, organizing, and executing complex investigations and audits.
• • Day-to-day responsibilities include performing data mining and analysis to detect anomalies in claims and medical records, handling complex investigations, mentoring SIU staff, developing FWA training and policies, conducting provider education, referring issues to regulators and law enforcement, creating and presenting FWA reports to senior leaders, serving as the primary point of contact for FWA inquiries, collaborating with stakeholders on fund recovery and resolutions, and leading investigations into agent broker fraud allegations.
• • Devoted Health, Inc. is a mission-driven healthcare company founded in 2017 that combines compassion, health insurance, clinical care, service, and technology to deliver integrated healthcare solutions for older Americans, serving members across the United States with a commitment to diversity, equality, and treating members like family.
• • In this role, the individual can develop expertise in healthcare fraud detection, lead complex investigations, influence fraud prevention policies, mentor junior investigators, collaborate with regulatory and law enforcement agencies, and contribute to the protection of federal healthcare funds while advancing their career in special investigations within a growing, purpose-driven organization.