Investigate instances of potential healthcare fraud, waste, and/or abuse (FWA) Conduct telephonic and/or in-person interviews of members, providers, and other related parties to gather information in support of investigations Review and analyze claims data to identify patterns and indications of potential FWA Conduct onsite provider investigations for claim and/or clinical audits as appropriate to gather and analyze all necessary information and documents related to the investigation Consider and synthesize information from claims data analysis, interviews, and other sources to guide confidential investigations, document relevant findings and report any illegal and otherwise suspect activities related to potential FWA in accordance with all laws and relevant regulations and other requirements Thoroughly document all investigative activities, present case findings to law enforcement and/or regulatory agencies and testify as required Meet or exceed job and task related requirements, guidelines, turn around times and SLAs governing each investigation Support Compliance, Regulatory, Legal, and Law Enforcement in all matters related to the investigation Prepare and present case facts and investigations to Legal, Client leadership and state regulators in face-to-face