Healthfirst

The Sr Investigator (SIU) will be responsible for effectively carrying out investigations of alleged Fraud, Waste and Abuse by providers, members, and others.

Conduct Indepth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving members, providers or other entities. Collect, utilize and interpret data obtained from a variety of computer generated reports and other sources, thereby identifying and documenting questionable patterns related to operation, and other practices which merit further investigation. Inform the Special Investigations Unit Director and Supervisor of potential or actual problem areas. Identify and suggest corrective action or improvement. Assist Special Investigations Unit Director and Supervisor with Fraud, Waste and Abuse issues, and perform other duties as necessary or assigned. Maintain assigned investigation files, document evidence, and prepare comprehensive investigation reports. Assist in conducting comprehensive interviews with employees, providers, members, employer groups, and witnesses to obtain statements and information admissible under generally accepted rules of evidence in criminal and civil court proceedings. Maintain a good working relationship with Healthfirst employees and all outside contacts of the Special Investigations Unit Department, including Federal, State and Local law enforcement agencies. Additional duties as assigned

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $65,600 - $94,775 All Other Locations (within approved locations): $58,300 - $86,700 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.