Investigator I

What you will do

• Conduct thorough investigations of assigned cases as identified through various detection sources.
• Understand and interpret data from various detection sources by working closely with analysts when required.
• Develop and execute the investigative plan to obtain evidence where fraud is suspected by contacting (verbal and/or written) appropriate parties, including plan member, claimant and/or provider.
• Document investigative actions and outcomes according to department policy.
• Determine and execute the appropriate action according to established protocols when evidence supports an action.
• Write client‑facing reports regarding investigative findings and comprehensive reports when cases are referred to special investigations.
• Communicate case information as necessary according to established protocols.
• Identify fraud and abuse risks and make recommendations to mitigate future risk. <...