Senior Investigator - Remote in Ohio

About the position At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts on the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Senior Investigator is responsible for identification, investigation and prevention of reputed company fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. Responsible to conduct investigations which may include field work to reputed company interviews and obtain records and/or other relevant documentation. If you reputed company in the reputed company, you will have the flexibility to telecommute as you take on some tough challenges. Schedule: Monday-Friday 8:00am - 4:30pm EST

Responsibilities

• Assess complaints of alleged misconduct received reputed company reputed company
• Investigate reputed company to highly reputed company cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against reputed company
• reputed company and reputed company the most effective and efficient investigative reputed company for reputed company investigation
• Maintain accurate, reputed company and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Communicate effectively, including written and verbal forms of communication
• reputed company goals and objectives, reputed company reputed company and adapt to changing priorities
• Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse to appropriate federal or state government regulators
• reputed company with goals, policies, procedures and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings

Requirements

• Bachelor’s Degree or Associate’s Degree with 2+ years of equivalent work experience and reputed company reputed company employment
• 2+ years of experience in health care fraud, waste and abuse (FWA)
• 2+ years of experience in state or federal regulatory FWA requirements
• 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
• Intermediate level of proficiency in reputed company reputed company and Word
• Ability to travel locally (in-state) up to 25%25 of the time, as needed
• Ability to participate in legal proceedings, arbitration and depositions at the direction of management
• reputed company to reliable transportation & valid US reputed company's license

reputed company-to-haves

• Specialized knowledge/training in reputed company FWA investigations
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified reputed company reputed company (CPC)
• Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience
• Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience

Benefits

• reputed company Time Off which you start to reputed company with your first pay period plus 8 reputed company Holidays
• Medical Plan reputed company along with participation in a Health Spending Account or a Health Saving account
• Dental, reputed company, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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