SIU Investigator - Remote

SIU Investigator - Remote

Prime Therapeutics (Prime) is a purpose‑driven Pharmacy Benefit Management company dedicated to improving patient outcomes. We are seeking a skilled investigator to conduct standard investigations of potential pharmacy, member, and prescriber fraud, waste, and abuse (FWA).

• Develop investigative plans and documentation to support investigations; evaluate impact of changing circumstances or newly discovered evidence.
• Obtain and review factual evidence, including invoice documentation, entity interviews, background checks, licensing information, and payment level data.
• Evaluate reports of potential fraud in SIU and recommend next steps; ensure investigative action aligns with department policy and practice.
• Adhere to evidentiary requirements in compliance with federal, state, and local laws; evaluate risk to determine how best to proceed with investigations.
• Recommend referrals to client SIUs, regulatory agencies, and/or law enforcement; recommend retention of experts or private investigators and other expenditures to support investigations.
• Other duties as assigned.

• Bachelor’s degree in Criminal Justice, Healthcare, or related area of study or equivalent combination of education and experience; HS diploma or GED required.
• 2 years of work experience in investigation, audit, healthcare, or legal.
• Must be eligible to work in the United States without need for work visa or residency sponsorship.

• Change‑agile with willingness and ability to adjust direction based on changing priorities and business need while working autonomously.
• Critical thinking, problem solving, and appropriate judgment to make decisions and provide risk advice to internal and external partners.
• Establish trust, respect, and credibility and form effective working relationships with individuals at all levels; collaborate cross‑functionally and with clients, law enforcement, and other stakeholders.
• Distill complex concepts into concise, compelling communications.
• Knowledge of pharmacy and medical claims processing environment.

• Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI).
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT).
• Licensed Practical Nurse (LPN) or Registered Nurse (RN).
• Experience working with claims processing systems.
• Prior experience analyzing claims and prior authorizations.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics LLC welcomes people of different backgrounds, experiences, abilities, and perspectives, including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco‑Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at or email