Senior Fraud Investigations Analyst

E-Verify Program

SIU Investigator conducting health care fraud investigations for Blue Cross NC. Responsible for timely investigations, documentation, and adherence to compliance regulations.

Posted 5/28/2026full-timeRemote • Kentucky, North Carolina, South Carolina, Wisconsin, Wyoming • 🇺🇸 United StatesSenior💰 $81,068 - $129,708 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

investigative action planerror identificationcontrol deficiency analysisinterviewingpresentation preparationcase data organizationdata trackingdata reviewingMedicare programs knowledgebilling requirements understanding

Soft Skills

communicationanalytical thinkingattention to detailproblem-solvinginterpersonal skills

Tools & Technologies

Excel

Certifications & Qualifications

AHFICFE

Industry Keywords

healthcare fraudcompliancereimbursement principleshealthcare educationinvestigative leads

About the role

Key responsibilities & impact

Conducts investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures
Identifies errors and control deficiencies.
May be required to provide deposition and/or testimony
Conduct interviews of victims, subjects and/or other related persons
Prepares and conducts presentations and/or provides content for health care fraud and abuse education and awareness.

Requirements

What you’ll need

Bachelor's degree or advanced degree (where required)
5+ years of experience in related field.
In lieu of degree, 7+ years of experience in related field.
Working knowledge of Medicare programs and reimbursement principles, including general billing requirements and documentation expectations
Professional certifications such as AHFI (Accredited Healthcare Fraud Investigator), CFE (Certified Fraud Examiner), or similar healthcare fraud or compliance credentials
Experience reviewing and vetting investigative leads and determining appropriate next steps
Strong Excel skills for organizing, tracking, and reviewing case data (e.g., filtering, sorting, basic formulas, pivot tables)

Benefits

Comp & perks

Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution