Integrity Management Services, Inc.

SIU Analyst – Investigator

Integrity Management Services, Inc.

full-time

Posted on:

Location Type: Remote

Location: Virginia • United States

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About the role

  • Identify and conduct investigations into known or suspected FWA with high autonomy
  • Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
  • Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)
  • Participate in the development and presentation of FWA-related education for assigned Customers
  • Perform coding reviews for flagged claims, to support Coding team (if applicable).

Requirements

  • Education:
  • - Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
  • - Experience:
  • - Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field.
  • - Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
  • - Experience handling confidential information and following policies, rules, and regulations
  • - Experience with commercial, Medicare, or Medicaid claims is highly preferred.
  • - Skills:
  • - Strong analytical and problem-solving skills, with attention to detail and accuracy.
  • - Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers.
  • - Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
investigationsroot cause analysiscoding reviewshealthcare claims analysisauditingpayment integrityfraud statutesregulationsclaims processingaudit software
Soft Skills
analytical skillsproblem-solving skillsattention to detailaccuracycommunication skillscollaboration