Special Investigative Unit Investigator (Eastern /Central Time Zone)

Department: Compliance & Legal Affairs (112120) Work Location: Remote – Candidates must reside in Eastern or Central Time Zones Duration: 12-week assignment (extension or conversion possible) Hours: 40 hours per week | 8 hours per day Days: Monday–Friday Pay Rate: $51.28 per hour (W2) Position Summary The Special Investigative Unit (SIU) Investigator conducts investigations into allegations of fraud, waste, abuse, and noncompliance across HAP product lines. This role requires advanced analytical capabilities, experience interpreting healthcare data, and the ability to independently manage complex, sensitive investigations, including coordination with regulatory and law-enforcement agencies. The investigator develops strategies, conducts audits, prepares detailed reports, identifies trends, and supports compliance initiatives to strengthen organizational integrity. Key Responsibilities • Assess allegations and determine if full investigation is warranted using internal and external data sources. • Develop investigative strategies, gather evidence, document findings, and assemble case files for adjudication. • Conduct interviews with providers, employees, members, and witnesses. • Perform on-site audits of provider records to assess billing integrity and compliance. • Prepare detailed investigative reports, including metrics, trends, schemes, and fraud referrals for regulators. • Coordinate with federal, state, and local law-enforcement agencies when appropriate. • Identify patterns, trends, and schemes through proactive data mining. • Manage a full investigative caseload from initiation through final disposition with minimal oversight. • Ensure compliance with OIG and organizational compliance-program elements. • Respond to allegations of policy or regulatory violations and recommend investigative actions. • Develop training related to fraud, waste, abuse, non-retaliation, Code of Conduct, and regulatory standards. • Collaborate with internal departments and maintain strong professional relationships. • Support department projects, process improvements, and compliance initiatives. Required Skills & Experience • Minimum 3 years of experience in healthcare, pharmacy technician work, claims adjudication, medical billing/coding, nursing, or law enforcement. • Minimum 2 years conducting healthcare investigations, preferably involving interaction with enforcement agencies. • Prior experience working for a health insurance payer. • Experience with FACETs or similar claims systems. • Proficiency in Excel (pivot tables, macros, formulas, Power Query) and ability to analyze large datasets. • Experience with RAT-STATS, data mining tools, or other investigative sampling systems. • Experience with Power BI and SQL preferred. • Strong analytical, auditing, communication, and report-writing skills. • Ability to work independently, manage multiple investigations, and handle sensitive information with discretion. • Strong organizational skills and adherence to confidentiality, HIPAA, and compliance standards. Required Education & Certifications • Bachelor’s degree required (Master’s degree or Law degree preferred). • CFE (Certified Fraud Examiner) or AHFI (Accredited Health Care Fraud Investigator) certification required. • Completion of Medical Terminology coursework within 6 months if not previously completed. Company DescriptionDella Infotech Inc is in the staffing business for 10 years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations. Apply tot his job Apply To this Job