SIU Investigative Analyst III (ATL)

You will act as a subject matter expert, overseeing reporting processes, analyzing fraud patterns, and collaborating with internal teams and regulatory agencies to strengthen program integrity. Our client supports large scale public healthcare programs and emphasizes compliance, accountability, and innovation to protect critical resources.

SIU Investigative Analyst III - Healthcare
Remote Opportunity West Coast Hours
Pay Rate: $32 to 41.99 per hour
Type: Contract Opportunity 16 Weeks

Company Overview
The Intersect Group partners with mission driven healthcare organizations committed to improving access, quality, and equity for underserved populations. Our client supports large scale public healthcare programs and emphasizes compliance, accountability, and innovation to protect critical resources. This is an opportunity to contribute to meaningful work in a highly regulated and impactful environment.

Role Summary
The SIU Investigative Analyst III plays a key role in the intake, triage, and regulatory reporting of healthcare fraud leads across multiple systems and channels. This position ensures timely and compliant reporting while supporting investigators through advanced data analysis and case development.

You will act as a subject matter expert, overseeing reporting processes, analyzing fraud patterns, and collaborating with internal teams and regulatory agencies to strengthen program integrity.

Key Responsibilities
• Oversee intake and triage of investigative leads including hotline complaints, referrals, and regulatory submissions
• Ensure all federal and state reporting requirements are met within mandated timelines
• Analyze claims, provider data, and referral information to identify suspicious patterns and potential fraud
• Maintain and support case management systems including healthcare fraud tracking and reporting tools
• Serve as a subject matter expert for reporting systems and act as a liaison for system enhancements
• Prepare clear, concise investigative and analytical reports to support case development
• Collaborate with investigators to provide data analysis support on complex cases
• Train and mentor junior team members on processes, systems, and reporting standards

Key Requirements
• Minimum 4 years of experience in healthcare fraud investigation or detection
• Strong knowledge of regulatory reporting requirements for Medicare, Medicaid, and related programs
• Proficiency in healthcare coding standards including CPT, HCPCS, ICD 10, CMS 1500, and UB04
• Experience with healthcare data systems such as HCFS, HPMS, or similar case management platforms
• Strong data analysis skills with proficiency in Excel, Word, PowerPoint, and reporting tools
• Knowledge of healthcare operations, claims processing, and fraud detection methodologies
• Excellent organizational skills with the ability to manage high volume workloads and strict deadlines
• Strong communication skills with the ability to present findings clearly and accurately

Preferred Qualifications
• Experience within SIU or payment integrity environments
• Certified Medical Coder or Accredited Healthcare Fraud Investigator designation
• Familiarity with Medi Cal, Medicare, or Medicaid programs
• Bilingual capabilities in Spanish or other commonly spoken languages

Call to Action
If you are a detail oriented analytical professional with experience in healthcare fraud detection and regulatory reporting, The Intersect Group encourages you to apply today. Submit your resume and contact information for immediate consideration.