COMPLIANCE INVESTIGATOR SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
Updated: Dec 24, 2024 - The Compliance Investigator brings robust expertise in Medicaid and Medicare regulations, adeptly communicating complex matters across various organizational levels. Equipped with exceptional skills in negotiation and conflict resolution, leads effectively in interviews and sensitive discussions. Offers a comprehensive background in healthcare fraud investigations, claims handling, and the development of anti-fraud programs, enhancing compliance and operational integrity.
Essential Hard and Soft Skills for a Standout Compliance Investigator Resume
- Regulatory Compliance
- Audit Techniques
- Claims Handling
- Data Analysis
- Legal Research
- Report Writing
- Healthcare Industry Knowledge
- Fraud Detection
- Technical Writing
- Policy Implementation
- Communication
- Negotiation
- Conflict Resolution
- Critical Thinking
- Problem Solving
- Leadership
- Detail-Oriented
- Ethical Judgment
- Adaptability
- Interpersonal Skills
Summary of Compliance Investigator Knowledge and Qualifications on Resume
1. BA in Criminal Justice with 4 years of Experience
- Experience in compliance, investigation, audit or another related area in the health care industry
- Comprehensive knowledge of fraud investigative procedures and judicial processes relating to fraud prosecutions
- Knowledge of Medicaid and Medicare regulations
- Proven ability to communicate complex subjects to all levels of associates, management and external contacts.
- Excellent communication, negotiation and conflict resolution skills, as well as the capability of taking the lead in interviews.
- Strong technical and business writing skills demonstrating the ability to write reports and business correspondence and to prepare case files.
- In-depth knowledge of the healthcare industry fraud, waste and abuse audit/investigations, and claims handling and payment operations.
- Ability to interact with others in one-on-one situations to identify issues/problems and provide training/coaching to correct problem areas.
- Experience creating and implementing a healthcare anti-fraud program.
- Ability to communicate effectively in writing.
2. BA in Health Care Administration with 6 years of Experience
- Knowledge of and skill in applying a wide range of complex, laws, regulations, policies and procedures sufficient to plan, conduct, and manage investigations or inquiries involving matters of personal conduct
- Knowledge of situations associated with alleged sexual harassment, hostile workplace, organizational mismanagement, and equal employment opportunity.
- Ability to select and apply investigative techniques, including skill in recognizing and resolving discrepancies or inconsistencies.
- Ability to conduct sophisticated surveillance.
- Skill in obtaining and reconstructing missing or withheld documents and information.
- Ability to develop supportable cases for presentation.
- Ability to analyze a myriad of diverse evidentiary materials and sources, regulations, procedures, and operations to make recommendations or propose solutions to and address allegations of inappropriate conduct.
- Ability to exercise ingenuity and innovation in devising solutions to systemic organizational problems or issues.
- Work well with banking systems.
- Prefer Legal background and experience in banking
- Working knowledge of applicable CTP/SOPs, EHS requirements, and application of cGMP/GDPs and other regulatory guidelines applicable to the medical/bio-tech industry.
3. BA in Legal Studies with 5 years of Experience
- Experience in a customer service type environment.
- Excellent inter-personal skills, ability to multi-task and positive attitude.
- Keen attention to detail and accuracy.
- Ability to prioritise workload and meet guidelines.
- Experience in Banking, KYC and AML solutions.
- Excellent research skill including experience with online research tools and databases.
- Strong analytical and a good understanding of conducting funds tracing and transaction analysis.
- Good knowledge/understanding of banking and financial services laws & regulations, compliance best practices and understanding of financial products & systems.
- The ability to work effectively, under pressure, in a rapid changing environment, as well as autonomously and as an effective member of a dynamic team.
- Strong interpersonal, communication and presentation skills.
- Working knowledge of Quality Systems.