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Commonwealth Care Alliance
Associate Investigator, FWA-SIUCommonwealth Care Alliance • Boston, MA, US
Associate Investigator, FWA-SIU

Associate Investigator, FWA-SIU

Commonwealth Care Alliance • Boston, MA, US
30+ days ago
Job type
  • Full-time
  • Remote
Job description

Why This Role is Important to Us


The Associate Investigator works with a growing team conducting and managing Health Care Fraud, Waste and Abuse investigation and prevention activities under the general direction of the Director or designee. Supervision Exercised: No

What You'll Be Doing


  • Plan, organize, and execute investigations or audits utilizing document review, witness interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate action.
  • Document and track activity in internal database, provide case updates on progress of investigation, and coordinate with management recommendations and further actions and/or resolutions.
  • Prepare detailed reports on investigative findings for internal tracking, review and referral to Federal and State agencies as indicated.
  • Utilize data mining and visualization programs to design queries and analyze claims data to detect outliers or suspicious patterns for further investigation.
  • Conduct detailed research to identify and apply appropriate regulatory, contractual and industry requirements to the different benefits and products within investigations.
  • Proactively seek out and develop leads, resources and opportunities from a variety of sources, and develop and maintain relationships with enterprise, industry, law enforcement and other contacts.
  • Complete special projects and audits as required.
  • Understand and adhere to HIPAA privacy requirements.
Working Conditions: Standard Office Conditions.
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Associate Investigator, FWA-SIU • Boston, MA, US

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