Special Investigation Unit Investigator

Centene Corporation

Special Investigation Unit Investigator investigating healthcare fraud, waste, and abuse for Centene. Reviewing claims and records, preparing case reports, and supporting program integrity recoveries.

Posted 9/6/2026full-timeRemote • Connecticut, New Jersey, New York, Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting fraud, waste, and abuse investigations within the healthcare sector, utilizing data analytics, claims analysis, and compliance knowledge to support case development and corrective actions. Proficient in preparing detailed investigative reports and collaborating with various stakeholders to ensure adherence to regulatory standards.

Highest-signal resume keywords

Fraud, Waste, And Abuse InvestigationsHealthcare Claims AnalysisInvestigative ReportingCompliance With Federal And State RegulationsAHFI, CFE, CPC, CPMA Certifications

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalyticsClaims Data ReviewMedical Records AnalysisBilling And Coding DocumentationFinancial Record ExaminationInvestigative ProtocolsOverpayment IdentificationAudit SupportCase DevelopmentCorrective Action Implementation

Soft Skills

CollaborationCommunicationAnalytical ThinkingAttention To DetailProblem Solving

Certifications & Qualifications

AHFICFECPCCPMA

Industry Keywords

Healthcare AdministrationFraud InvestigationCompliance StandardsInsurance ClaimsProvider Billing PracticesEconomic InvestigationsRegulatory AgenciesLaw Enforcement CollaborationProgram Integrity InitiativesPrivacy Standards

About the role

Key responsibilities & impact

Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, interviews, data analytics, and other investigative resources
Analyze, document, and maintain investigative activities, findings, recommendations, and outcomes
Review claims, medical records, provider billing practices, enrollment information, financial records, and other documentation for potential fraud, waste, abuse, overpayments, or compliance concerns
Prepare investigative reports, case summaries, referrals, and supporting documentation for internal stakeholders, regulatory agencies, law enforcement entities, and other authorized parties
Collaborate with business partners, compliance, legal, provider and payment integrity teams, and external agencies
Support corrective actions, recoveries, audits, overpayment identification and recovery, regulatory responses, special projects, and program integrity initiatives
Monitor emerging fraud schemes, billing irregularities, and healthcare program risks and recommend appropriate actions
Support case progression through onsite audits, visits, drive-by activities, and interviews
Comply with all policies and standards and perform other duties as assigned

Requirements

What you’ll need

Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience
An Associates or Bachelor's degree in criminal justice or a related field; or employment as an investigator in the MMCO's SIU on or before the effective date of this SubPart
Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, or seven years of professional investigation experience involving economic or insurance related matters
Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records to support investigations and case development preferred
AHFI, CFE, CPC, CPMA, or other related investigative, auditing, or compliance certification preferred
Compliance with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies and procedures

Benefits

Comp & perks

Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules