Investigator, Special Investigations Unit (Aetna SIU)

Greetings,Aetna is seeking a highly skilled and motivated Investigator to join our Special Investigations Unit (SIU). As an Investigator at Aetna, you will play a crucial role in detecting and investigating potential fraud, waste, and abuse within our organization and protecting our members and the integrity of our healthcare system.To excel in this role, you must possess strong analytical skills, attention to detail, and the ability to think critically and objectively. You must also have a passion for solving complex problems and a commitment to upholding ethical standards. If you are a team player with excellent communication and interpersonal skills, and have experience in conducting thorough investigations, we encourage you to apply for this exciting opportunity with Aetna's SIU.

Conduct thorough investigations into potential cases of fraud, waste, and abuse within the organization.
Utilize strong analytical skills to gather and analyze data, identifying patterns and discrepancies that may indicate fraudulent activity.
Review medical records, claims data, and other relevant documents to assess the validity of claims and detect potential fraud.
Work closely with other members of the SIU team to identify and prioritize cases for investigation.
Interview individuals involved in potential cases of fraud to gather additional information and evidence.
Collaborate with external agencies and law enforcement as needed to gather information and support investigations.
Maintain accurate and detailed documentation of investigations, findings, and outcomes.
Keep up-to-date with industry trends and best practices in fraud detection and investigation.
Communicate findings and recommendations to management and other stakeholders in a clear and concise manner.
Maintain strict adherence to ethical standards and confidentiality when handling sensitive information.
Support the organization's efforts to prevent and mitigate fraudulent activity through training and education initiatives.
Serve as a subject matter expert and resource for other team members and colleagues.
Demonstrate a strong commitment to upholding Aetna's values and mission.
Adhere to all regulatory and compliance requirements related to investigations.
Act as a positive representative of Aetna and the SIU team in all interactions with internal and external stakeholders.

Aetna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

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