Job Description
We’re looking for a Clinical Healthcare Fraud Investigator to support a high volume of claims for a leading healthcare client. This role owns full-cycle investigations from intake through closure, leveraging deep clinical, coding, and regulatory expertise. You’ll act as a subject matter expert, driving investigative strategy, supporting cross-functional partners, and mentoring other investigators.
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
3+ years of healthcare fraud investigations experience (full lifecycle)
4+ years of medical coding experience
Strong experience reviewing claims, clinical documentation, and billing practices
Expertise in coding systems (CPT, HCPCS, ICD-10) and reimbursement models
Proven ability to lead complex investigations, conduct interviews, and produce detailed reports
Strong knowledge of fraud schemes (e.g., upcoding, unbundling, billing fraud)
Experience working within regulatory and compliance frameworks (CMS, Medi-Cal/Medicare)
Proficiency in Excel and data/BI tools (Power BI or Tableau)
Strong communication, organization, and ability to manage multiple cases
Nice to Have Skills & Experience
Certifications: CFE, AHFI, CHC, Lean Six Sigma
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.