SIU Investigator

Ready to be the ultimate fraud fighter? If you have a nose for the truth and a passion for protecting healthcare resources, PrimeWest Health needs your investigative expertise!
As our SIU Investigator, you aren't just filing reports—you’re the front line against fraud, waste, and abuse. You’ll dive deep into Medicare and Medicaid business lines, turning raw data and initial allegations into rock-solid cases. From the first spark of suspicion to the final referral to law enforcement, you own the investigation.
Why this role kicks it up a notch:
The Lead Detective: You are the organization’s primary resource for all things investigative.
Total Case Ownership: You’ll identify, develop, and resolve cases, managing everything from high-stakes evidence collection to complex data analysis.
Collaborative Impact: You’ll work side-by-side with internal teams, county partners, and external agencies to stop noncompliance in its tracks.
Strategic Influence: Support the Corporate Compliance/HIPAA Privacy Officer by providing the subject matter expertise needed to keep our program integrity ironclad.

Education & Experience: Bachelor’s degree in Business or a related field (preferred); equivalent experience in healthcare compliance, fraud investigation, auditing, or medical coding is also accepted.

Experience: Proven background in healthcare investigations, medical record auditing, provider profiling, or program integrity—ideally within a health plan or regulatory agency.
Technical Knowledge: Proficiency with CPT, HCPCS, and ICD-10 code sets.
Tech Savvy: Strong Microsoft Office skills required; experience with claims processing or data systems is a major plus.

Core Competencies

Investigative Skills: Ability to independently research complex issues, analyze data, and manage multiple investigations simultaneously.
Analytical Thinking: Strong problem-solving, negotiation, and conflict-resolution skills.
Compliance Expertise: Ability to interpret and implement healthcare compliance guidelines and regulatory requirements.
Communication: Excellent verbal and written skills to present complex findings clearly to diverse audiences.
Professional Standards
Attention to Detail: Exceptional organizational skills and a commitment to maintaining strict confidentiality.
Judgment: Proven ability to exercise sound, independent judgment in sensitive situations.
Work Ethic: Adaptable to evolving tasks, willing to learn new skills, and committed to meeting deadlines.
Physical & Travel Requirements
Ability to work at a computer for extended periods, occasionally lift up to 20 lbs, and travel as needed.

Why You’ll Love Working Here:

Comprehensive Benefits – Medical, dental, and vision coverage.
Generous Paid Time Off – Vacation, sick, holidays, and personal days.
Pension-Public Employee Retirement Association (PERA)
Professional Growth – On-the-job training and development opportunities.
Work-Life Balance – Regular business hours and a positive team culture.
Onsite Fitness Center

If you’re a subject matter expert who loves solving puzzles and ensuring corrective actions stick, it’s time to bring your skills to a team that values integrity as much as you do.

Ready to protect the integrity of PrimeWest Health? Apply today!