Investigation Advisor - Group Insurance
Core
Investigate suspected fraud and abuse in health and dental insurance claims, analyze data to identify suspicious patterns, and prepare reports for clients.
Role type
Senior IC fraud investigation advisor
Builds
Fraud detection mechanisms and investigation processes
Domain
Insurance / Healthcare / Financial Services
Deliverable
client delivery
Required skills
fraud investigation, data analysis, critical thinking, report writing, stakeholder management, process improvement
Preferred skills
experience with fraud detection tools, knowledge of emerging fraud trends
Technologies
fraud detection tools, analytical tools
Responsibilities
Review referrals regarding suspected fraud; Analyze alerts and conduct independent data analysis; Conduct thorough investigations by gathering evidence; Document findings and prepare reports; Partner with analytics teams to enhance detection rules; Manage escalated cases
Seniority
Mid-level, hands-on IC