Investigations Consultant
On-site · Pittsburgh, Pennsylvania, United States
Job Summary
Investigator role focusing on strategic audits to identify overbilling and recoveries, mentoring investigative staff, preparing cases for legal authorities, and leading special investigations in healthcare fraud, waste, and abuse. Requires collaboration with internal audit teams and external vendors, ability to testify in court, and strong expertise in claims processes across professional, hospital, ambulatory surgical center, home health, and durable medical equipment. Must analyze data, communicate findings to management, negotiate settlements, and guide project teams. Bachelor's degree in a related field and substantial experience in healthcare fraud investigations are required; CPA/CFE/CPC credentials are preferred. Travel up to 25% may be required.
Required Qualifications
- Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field
- 7 years of in the Health Insurance industry and/or Healthcare Fraud investigations
- 3 years in leading projects of varying size and complexity
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