Special Investigation Unit Investigator II (ATL)

Special Investigation Unit Investigator II - Healthcare
Remote Opportunity - - West Coast Hours 
Pay Rate: $43- $48 per hour
Remote Contract Opportunity 16 Weeks

Company Overview
The Intersect Group partners with leading healthcare organizations committed to improving access, quality, and outcomes for underserved populations. Our client operates one of the largest public health programs in the country, delivering essential services to millions while maintaining a strong focus on compliance, integrity, and accountability. This is an opportunity to contribute to meaningful work that protects critical healthcare resources.

Role Summary
The Special Investigation Unit Investigator II is a key contributor responsible for conducting complex investigations into suspected healthcare fraud, waste, and abuse. This role works independently to evaluate claims activity, gather evidence, and ensure investigations are handled objectively and in full compliance with regulatory guidelines.

This position plays an important role in identifying risk patterns, supporting enforcement actions, and safeguarding healthcare program integrity through data driven insights and detailed case development.

Key Responsibilities
• Conduct independent investigations into suspected fraud involving providers, members, and vendors
• Review claims data, billing records, and provider activity to identify irregular patterns and potential abuse
• Analyze healthcare data to detect unusual billing trends and proactively develop investigative leads
• Prepare comprehensive investigative reports documenting findings, evidence, and conclusions
• Participate in onsite audits and support investigations referred to regulatory or law enforcement agencies
• Maintain proper documentation standards including chain of custody and confidentiality requirements
• Collaborate with internal teams and external partners to support case resolution and enforcement actions
• Assist with recovery efforts by supporting overpayment identification and recoupment processes

Key Requirements
• Minimum 3 years of healthcare fraud investigation or related healthcare experience such as pharmacy, DME, behavioral health, dental, hospice, or home health
• Bachelor’s degree in criminal justice, accounting, healthcare administration, or related field or equivalent experience
• Experience conducting investigations including interviews, data analysis, and report writing
• Strong analytical skills with the ability to interpret claims data and identify fraud indicators
• Proficiency with Microsoft Excel and Word for data analysis and documentation
• Knowledge of healthcare regulations including Medicaid and Medicare billing practices
• Excellent written and verbal communication skills with strong attention to detail
• Ability to manage multiple investigations, prioritize workload, and meet deadlines

Preferred Qualifications
• Certified Fraud Examiner, Accredited Healthcare Fraud Investigator, or Certified Professional Coder designation
• Experience working within an SIU or payment integrity environment
• Bilingual proficiency in Spanish or other commonly spoken languages
• Familiarity with emerging fraud schemes and healthcare operational processes

Call to Action
If you are an experienced investigator seeking a high impact role in healthcare compliance and fraud prevention, The Intersect Group encourages you to apply today. Submit your resume and contact information for immediate consideration.