Senior SIU Investigator

Centene
New York, Massachusetts, Pennsylvania, Connecticut, Florida, New Jersey, Missouri
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Solutions Engineering & Sales EngineeringExperience: 4+ yearsEducation: bachelorsSkills: ["Stakeholder management","Investigation","Communication","Analytical thinking"]

Independently lead complex fraud, waste, and abuse (FWA) investigations across healthcare entities, using claims, billing, medical records, interviews, and analytics to identify misconduct and compliance risks. Develop investigation strategies, manage case direction through resolution, and produce comprehensive reports, referrals, and recommendations for leadership, regulators, and law enforcement. Serve as a subject matter resource and support audits, recoveries, corrective actions, and continuous process improvements.

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Centene
Centene
1 day ago

Senior SIU Investigator

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Last checked: 11 hours agoStatus: Live

Job Summary

Independently lead complex fraud, waste, and abuse (FWA) investigations across healthcare entities, using claims, billing, medical records, interviews, and analytics to identify misconduct and compliance risks. Develop investigation strategies, manage case direction through resolution, and produce comprehensive reports, referrals, and recommendations for leadership, regulators, and law enforcement. Serve as a subject matter resource and support audits, recoveries, corrective actions, and continuous process improvements.
Location: New York, Massachusetts, Pennsylvania, Connecticut, Florida, New Jersey, Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Mid level

Key Responsibilities

  • •Independently lead complex fraud, waste, and abuse (FWA) investigations involving providers, members, pharmacies, vendors, and other entities.
  • •Analyze claims, billing patterns, medical records, provider documentation, and financial information to identify potential fraud, waste, abuse, and compliance concerns.
  • •Develop investigative strategies and manage case direction through resolution in accordance with laws, regulations, contractual requirements, and organizational policies.
  • •Prepare comprehensive investigative reports, referrals, and case summaries for leadership, regulatory agencies, law enforcement, and other authorized stakeholders.
  • •Serve as a subject matter resource, identify emerging fraud schemes and program integrity risks, and support audits, recoveries, regulatory responses, and training/knowledge sharing.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Perks:Health Insurance401kPaid LeaveEquity

Key Requirements

  • •Bachelor’s degree in Business, Criminal Justice, Healthcare Administration, Public Health, or related field (or equivalent experience).
  • •4+ years conducting fraud, waste, and abuse investigations, healthcare fraud investigations, claims audits, payment integrity reviews, healthcare compliance investigations, law enforcement investigations, or related work.
  • •Experience leading complex investigations using multiple data sources and coordinating with internal and external stakeholders.
  • •Experience preparing investigative reports, referrals, presentations, and supporting documentation for leadership, regulators, and law enforcement.
  • •Experience interpreting and applying federal and state healthcare regulations, including Medicaid and Medicare (preferred).
Experience:4+ yearsHealthcareFraud investigationsCompliance
Education:Bachelor's
Skills:Stakeholder managementInvestigationCommunicationAnalytical thinking
Certifications:AHFICFECPCCPMA

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn