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US 3w PTO

  • Investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis and interviews.
  • Analyze information, report findings, and recommend settlements or denials while supporting legal proceedings.
  • Conduct training on fraud detection and maintain knowledge of relevant laws and regulations.

Excel Data Analysis Investigation Communication Attention To Detail

4 jobs similar to Senior Investigator (Healthcare FWA)

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US

  • Identify fraud, waste, and abuse patterns in Medicaid home and community-based care data.
  • Translate findings into scalable detection capabilities embedded within the HHAeXchange platform.
  • Collaborate with product, engineering, and customer teams to ensure detection logic is operationally sound and actionable.

HHAeXchange is a leading technology platform for home and community-based care, providing an end-to-end homecare solution for aging or disabled individuals. Founded in 2008, the company employs passionate professionals transforming healthcare by connecting patients, providers, managed care organizations, and states.

US Unlimited PTO

  • Conduct investigations of high-risk or potential fraud activity, including platform abuse and suspicious financial movement patterns.
  • Use an investigative, data-driven approach to analyze cases and make fair, compliant, and risk-mitigated determinations.
  • Leverage tools such as Excel, Google Sheets, Snowflake, SQL, and Tableau to uncover fraud patterns and communicate findings to stakeholders.

Clair is a digital banking platform that gives America's workers instant access to their earned wages by embedding financial products into payroll and workforce management apps. The company is a fintech startup with a focus on financial freedom for hourly workers.

USA

  • Investigate and analyze suspected fraud cases affecting Veriff’s customers.
  • Develop new countermeasures and strategies to address emerging fraud patterns while minimizing false positives.
  • Collaborate with cross-functional teams to improve fraud detection processes and ensure product readiness.

Veriff is a global identity verification platform that helps businesses verify and safeguard users online. The company is backed by investors including Accel, Alkeon, IVP, Tiger Capital, and Y Combinator, has offices in the US, UK, Spain, and Estonia, and is dedicated to being a benchmark for trust online.

US

  • Monitor merchant processing activity to identify suspicious transactions and potential fraud.
  • Investigate alerts and review reports to mitigate company losses and ensure compliance.
  • Collaborate with cross-functional teams to design risk strategies and maintain SOPs.

Xplor provides cloud-based technology solutions for small and medium-sized businesses to manage payments and operations, processing over $47 billion annually for 130,000+ businesses in 72+ countries. The company is backed by investors Advent International, Battery Ventures, and Silver Lake, and fosters a culture guided by values of simplicity, purpose, community, and people-first.