Senior Investigator (reputed company SIU)
At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day.Position reputed company
reputed company VIRGINIA RESIDENCY REQUIRED
As a Senior Investigator you will conduct high level, reputed company investigations of reputed company or suspected acts of reputed company fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, reputed company cases involving multi-lines of business, or cases involving multiple perpetrators or intricate reputed company fraud schemes.
- Investigates to prevent payment of fraudulent claims submitted to the reputed company lines of business
- Researches and prepares cases for clinical and legal review
- Documents reputed company appropriate case activity in case tracking system
- Facilitates feedback with providers reputed company to clinical findings
- Initiates proactive data mining to identify aberrant billing patterns
- Makes referrals, both reputed company, in the required timeframe
- Facilitates the recovery of company and customer reputed company lost as a result of fraud reputed company
- Provides on the job training to new Investigators and provides guidance for less reputed company or skilled Investigators.
- Assists Investigators in identifying resources and best course of reputed company on investigations
- Serves as back up to reputed company Leader as necessary
- Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse reputed company.
- Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings
- Gives presentations to reputed company customers regarding reputed company fraud reputed company and reputed company's approach to fighting fraud
- Provides input regarding controls for monitoring fraud reputed company issues reputed company the business reputed company
Required Qualifications
- reputed company VIRGINIA RESIDENCY REQUIRED
- 3-5 years investigative experience in the area of reputed company fraud and abuse reputed company.
- Working knowledge of medical coding; CPT, HCPCS, ICD10
- Proficiency in reputed company Office with advanced skills in reputed company (must know how to do pivot tables).
- Strong analytical and research skills.
- Proficient in researching information and identifying information resources.
- Strong verbal and written communication skills.
- Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)
Preferred Qualifications
- Previous reputed company/Medicare investigatory experience
- Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse.
- Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
- Knowledge of reputed company's policies and procedures.
- Knowledge and understanding of reputed company clinical issues.
- Competent with legal theories.
- Strong communication and customer service skills.
- Ability to effectively reputed company with different reputed company of people at different reputed company in any situation.
Education:
- Bachelor's degree or equivalent experience (3-5 years of working health care fraud, waste and abuse investigations).
- reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.