Special Investigation Unit Investigator

Centene Corporation

Special Investigation Unit Investigator investigating healthcare fraud, waste, and abuse for Centene. Reviewing claims, medical records, and provider data to support program integrity and case resolution.

Posted 8/27/2026full-timeRemote • Montana • 🇺🇸 United StatesJuniorMid-Level💰 $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 healthcare, utilizing data analytics and investigative resources. Proficient in analyzing claims, medical records, and provider billing practices while ensuring compliance with regulatory standards.

Highest-signal resume keywords

Fraud, Waste, And Abuse InvestigationsHealthcare ComplianceClaims AuditsData AnalyticsAccredited Healthcare Fraud Investigator (AHFI)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ReportingClaims AnalysisMedical Record ReviewBilling And Coding DocumentationFinancial Record Analysis

Soft Skills

CollaborationCommunicationAnalytical Thinking

Certifications & Qualifications

Certified Fraud Examiner (CFE)Certified Professional Coder (CPC)Certified Professional Medical Auditor (CPMA)

Industry Keywords

Healthcare InvestigationsPayment IntegrityRegulatory ComplianceFraud SchemesOverpayment Identification

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
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 efforts, 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 member, provider, and witness interviews
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience
2+ years of fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field
Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records to support investigations and case development preferred
Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (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

Competitive pay
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
Additional forms of incentives may be included in total compensation