Fraud and Waste Investigator

Candidates must possess a Registered and/or Pharmacy Technician Certification and at least 3 years of experience in retail, specialty, or mail order pharmacy or equivalent experience in FWA investigations. A minimum of 3 years of experience with pharmacy and/or medical FWA investigations is required, along with in-depth knowledge of the healthcare industry, claims processing, and payment methodologies. Strong organizational, interpersonal, and communication skills are essential, as is the ability to work independently, self-motivate, and prioritize cases with minimal oversight. Extensive understanding of investigative procedures, strong analytical skills with the ability to create and interpret metrics and data, and proficiency in Microsoft Office, particularly Excel, are also necessary. A high standard of personal and professional ethics and a willingness to travel up to 15% are required. Preferred qualifications include CFE and/or AHFI Certifications, a Bachelor's degree or other professional certifications/advanced degrees, and experience developing investigative processes and creating/revising policies.