Job Description
We’re looking for a Senior Healthcare Claims Investigator to support a high volume of claims for a leading healthcare client. In this role, you’ll lead complex fraud, waste, and abuse investigations by reviewing claims, patient records, and billing data to identify suspicious activity. You’ll conduct interviews, gather evidence, and produce detailed reports while partnering with legal teams and external agencies to ensure compliance with regulatory requirements. You’ll also analyze trends across cases, support audits, and act as a subject matter expert, helping guide investigation strategy and mentor junior team members.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
5+ years in healthcare fraud investigations.
Strong experience with data analysis, interviews, and case development.
Analytical, investigative, and problem-solving expertise.
Strong communication, organization, and compliance mindset.
Proficient in Excel (advanced data analysis); Access preferred.
Nice to Have Skills & Experience
Certifications: AHFI, CFE, CPC
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.