SIU Investigator

Job Description
Insight Global is looking for a Mid-level Investigator responsible for conducting complex, independent healthcare fraud, waste, and abuse (FWA) investigations. Ensures investigations are accurate, compliant, and well-documented while supporting law enforcement and regulatory efforts.

Bottom Line
Independently investigates suspected fraud cases, leveraging data and evidence to support compliant, well-documented outcomes and regulatory actions.

Core Responsibilities:
Investigations
 • Conduct end-to-end investigations into suspected fraud involving providers, members, and claims
 • Analyze claims data, billing patterns, and system records to identify suspicious activity
 • Gather evidence, perform interviews, and produce detailed investigative reports

Regulatory & Legal
 • Submit fraud referrals to CMS, DHCS, and law enforcement within required timelines
 • Support investigations with external agencies (DOJ, FBI, local la...