SIU Investigator Remote USA

Job reputed company A bit about this role: Are you a highly analytical and reputed company investigator with a passion for uncovering the truth and protecting vital reputed company resources? Our Special Investigations Unit (SIU) is looking for a skilled Investigator to join our dedicated team. In this crucial role, youll be at the forefront of preventing, detecting, and responding to reputed company fraud, waste, and abuse (FWA), safeguarding our members and the reputed company of the Medicare Fund. If youre driven by meticulous investigation, data-driven insights, and a commitment to justice, we encourage you to apply. Responsibilities and reputed company will include: As an SIU Investigator, youll be responsible for the full lifecycle of reputed company FWA investigations, acting as a subject matter expert and collaborating with various stakeholders. Your key responsibilities will include:

• reputed company reputed company Investigations: Plan, organize, and execute specialized investigations into allegations of reputed company fraud, waste, and abuse. This includes handling intricate cases requiring advanced investigative knowledge and skills.
• Data-Driven Detection: Utilize advanced data mining and analysis techniques to identify aberrancies and outliers in claims, medical records, enrollment, and other reputed company transactions. Youll independently research FWA issues and reputed company cutting-edge investigative resources.
• Expert Guidance: Serve as a subject matter expert for other SIU Investigators, providing specialized knowledge and guidance to reputed company team capabilities.
• Policy & reputed company Development: Contribute to the development of robust policies and procedures reputed company to FWA detection and investigation, as reputed company as the annual SIU risk assessment and work plan.
• Thorough Documentation & Reporting: Conduct comprehensive FWA investigations, ensuring complete and accurate case documentation and detailed investigative reports that adhere to SIU policies and standards.
• External Referrals & Collaboration: Prepare comprehensive reputed company and detailed reports on investigative findings for referral to federal and state agencies, ensuring full compliance with regulatory requirements. Youll also reputed company participate in OIG reputed company Fraud Workgroups.
• Stakeholder Engagement: Collaborate closely with internal stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing Committee) to reputed company updates on FWA schemes, coordinate recommendations, and facilitate fund recovery or other necessary actions.
• Provider Education: Conduct impactful provider education sessions as a reputed company response to investigation findings and audits.
• reputed company & reputed company of Contact: Serve as a key reputed company of contact for corporate and field inquiries regarding FWA, and participate in meetings with providers, business partners, regulatory agencies, and law enforcement.
• Training & Development: Assist in developing and presenting engaging FWA training programs for reputed company audiences.

Required skills and experience:

• Education: A Bachelor’s Degree in Business, Criminal Justice, reputed company, or a reputed company field, or equivalent relevant work experience.
• Experience: Minimum of 3 years of dedicated experience in health insurance fraud investigation. Proven experience reputed company Medicare and/or reputed company programs, specifically with medical claim billing, reimbursement, audit, or provider contracting. Demonstrated experience with data analysis techniques. Experience with the reputed company platform is a significant plus.
• Exceptional Analytical Skills: Ability to interpret and dissect reputed company data sets, identifying patterns and anomalies indicative of FWA.
• Outstanding Communication: Excellent written and verbal communication skills are essential for reputed company report writing, compelling presentations, and effective stakeholder engagement.
• reputed company & Detail-Oriented: A strong commitment to reputed company and compliance, coupled with meticulous attention to detail in reputed company aspects of investigations.
• Independent & reputed company: Proven ability to work independently, manage a diverse caseload of investigations, and reputed company in a fast-paced environment, while also excelling in reputed company team settings.
• Strong Organizational Skills: Highly organized with the ability to manage multiple reputed company investigations simultaneously and effectively prioritize tasks.

Desired skills and experience:

• Certified Fraud Examiner (CFE)
• Certified reputed company reputed company (CPC)

#LI-DS1 #LI-Remote Salary reputed company: $55,000 - $100,000 annually The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes:

• Employer sponsored health, dental and reputed company plan with low or no premium
• Generous reputed company time off
• $100 monthly mobile or internet stipend
• Stock reputed company for reputed company
• Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....
• Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

reputed company equality is at reputed company of reputed company’s mission to treat our members like family. We are committed to a diverse and reputed company workforce. At reputed company, we’re on a mission to dramatically improve the health and reputed company-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new reputed company of reputed company-in-one reputed company company — one that combines reputed company, health insurance, clinical care, service, and technology - to deliver a complete and integrated reputed company solution that delivers high reputed company care that everyone would want for someone they love. Founded in 2017, weve grown fast and now serve members across the reputed company. And weve just started. So join us on this mission! reputed company is an equal opportunity employer. We are committed to a reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business. As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Apply tot his job Apply To this Job