Special Investigative Unit Investigator

Troy, MI - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Job Title: Special Investigative Unit (SIU) Investigator

Department: Compliance & Legal Affairs
Location: Remote
Schedule: 40 hours/week 8 hours/day
Start Date: 12/15/2025
Estimated End Date: 03/14/2026
Assignment Length: 12 weeks
Schedule Notes: Remote position Candidates MUST reside in Eastern or Central Time Zones

Position Summary

We is seeking highly skilled Special Investigative Unit (SIU) Investigators to support the Compliance & Legal Affairs Department. The SIU Investigator will lead investigations related to reports of non-compliance fraud waste and abuse within the organization and across healthcare operations. The role requires strong analytical capabilities independent judgment meticulous attention to detail and the ability to manage sensitive and complex cases often involving regulatory or law enforcement agencies.

Principal Duties & Responsibilities

Investigative Responsibilities

Independently analyze public and internal HAP data to develop preliminary assessments and determine need for full investigations.
Develop investigative strategies and execute end-to-end investigations including high-profile and complex healthcare fraud cases.
Collect assemble and document evidence required for proper adjudication.
Conduct on-site audits of provider records focusing on billing appropriateness and compliance.
Conduct interviews with providers employees members and witnesses.
Prepare detailed investigative and audit reports summarizing trends metrics and findings for stakeholders and enforcement agencies.
Create well-structured fraud referrals for regulators detailing alleged fraudulent activities.
Coordinate and collaborate with law enforcement and regulatory authorities.

Compliance & Program Support

Ensure adherence to OIG-effective compliance program elements by addressing issues promptly.
Manage an independent caseload including tracking trending and reporting non-compliance.
Recommend and initiate investigative procedures for alleged violations of policies regulations or Code of Conduct.
Support operation of the compliance program by ensuring processes prevent illegal unethical or improper conduct.
Proactively develop new cases using data mining tools and findings.
Respond to complaints document statements and identify instances of fraud waste or abuse.
Identify patterns trends and schemes to generate new investigative leads.
Develop and deliver compliance-related training (FWA HFH Non-retaliation policy Code of Conduct etc.).

Teamwork & Collaboration

Work effectively as part of the SIU team contributing to collective goals.
Demonstrate adaptability and willingness to support various investigative tasks as needed.

Required Skills & Competencies

Experience using RAT-STATS or similar tools for sampling and extrapolation.
Strong proficiency in Excel: data analysis macros pivot tables Power Query automation and visualization.
Experience with Microsoft Power BI and working SQL knowledge preferred.
Excellent verbal written and presentation skills.
Strong analytical investigative and auditing skills with an inquisitive mindset.
Knowledge of healthcare industry product lines (Medicare Medicaid ACA commercial).
Strong understanding of healthcare payment methodologies.
Experience with FACETs or similar claims systems.
Strong interpersonal organization and communication skills.
Ability to work effectively with diverse groups at all levels.
High level of personal and professional ethics.
Must meet client customer service standards in communication sensitivity teamwork and understanding.

Education & Experience Requirements

Required:

Bachelors Degree
Minimum 3 years of experience in healthcare pharmacy technician roles claims adjudication medical billing/coding nursing or law enforcement
Minimum 2 years conducting comprehensive investigations preferably with law enforcement collaboration
Previous experience working for a health insurance payer
Previous experience using FACETs system
CFE (Certified Fraud Examiner) or AHFI (Accredited Healthcare Fraud Investigator) certification

Preferred:

Masters Degree or Law Degree
Experience with SQL Power BI advanced data analytics tools
Knowledge of government program requirements (Medicare Medicaid ACA)

Physical Demands / Working Conditions

Standard office environment with minimal exposure to noise or temperature changes.
Sedentary role may require occasional lifting up to 10 lbs.
Frequent talking and hearing required to perform job functions.
Remote role with occasional need for travel if required for audits or investigations.

Job Title: Special Investigative Unit (SIU) Investigator Department: Compliance & Legal Affairs Location: Remote Schedule: 40 hours/week 8 hours/day Start Date: 12/15/2025 Estimated End Date: 03/14/2026 Assignment Length: 12 weeks Schedule Notes: Remote position Candidates MUST reside in Eas...