State Licensed Senior Investigator

A company is looking for a Senior Investigator (Healthcare FWA) Provider Escalations.

Key Responsibilities

Act as the primary contact for escalated provider-related concerns and ensure timely resolution

Educate providers on claim determinations and relevant guidelines

Document investigations and prepare reports for internal and external use

Required Qualifications

Bachelor's Degree in a related discipline or equivalent experience

5-8 years of related investigative experience

Experience in proactive data mining and data extrapolation

Advanced level skills in Excel

Certified Professional Coder (CPC) certification required