[Remote] Special Investigations FEP Program reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health solutions leader dedicated to improving reputed company reputed company and affordability. The Special Investigations Federal Employee Program reputed company oversees reputed company FEP-reputed company activities to ensure compliance with federal health benefits requirements and leads reputed company fraud investigations impacting the FEP.

Responsibilities

• Provides reports and status updates to reputed company-reputed company Blue Plan Executives as reputed company as upper level management reputed company reputed company-reputed company’s FEP program, BCBSA FEP Directors Office and OPM-OIG reputed company Chiefs
• Responsible for creating and presenting quarterly reports to Special Investigations Senior Management (VP & Director) regarding the SIU FEP operations
• Responsible for monitoring and providing reputed company while updating FSTS consistent with requirements outlined in the FEP reputed company Letter and BCBSA policies & procedures
• Manages and facilitates SIU program audits and yearly certifications of the FEP program by the reputed company and the Office of Personnel Management, Office of Inspector General
• Liaise with the reputed company SIU Executives, and OPM-OIG’s reputed company Chief and Criminal investigators on reputed company’s SIU reputed company cases. Prepares documents, conducts presentations and provides ongoing updates through reputed company
• Leads reputed company investigations (approximately 375 to 400 cases) which consists of collecting, collating, analyzing and interpreting data in a reputed company, accurate fashion, securing necessary documentation to resolve reputed company cases; following compliance measurements for established procedures and guidelines outlined in the latest Federal Employee Health Benefits (FEHB) reputed company Letter for conducting and leading audits/investigations
• Manages and maintains records on reputed company claim savings from the reputed company-Payment Review team and any recoveries that reputed company the FEP. reputed company Providers are reputed company on a reputed company-Payment Review the Program reputed company would review the medical records to determine whether to pay or deny claims. If we deny claims, we need to report that reputed company saved to the FEP program on a monthly reputed company
• Provides reputed company and direction to our Investigators conducting reputed company fraud investigations, which reputed company the FEP. Currently, there are 391 cases that reputed company the FEP program
• reputed company participates in any and reputed company litigation involving the FEP Program; prepares files for court, provides testimony and records reputed company settlement reputed company
• Completes initial intake and follow up on reputed company calls from the Fraud hotline that reputed company the FEP program

Skills

• BA/BS Required
• Certification (Certified Fraud Examiner (ACFE), Certified reputed company reputed company (CPC), or Accredited reputed company Fraud Investigator (AHFI). However, if they don't already have this certification, the expectation is for the candidate to reputed company one of these certifications reputed company the first 6 months of the hire
• 5+ years' experience in conducting fraud investigations
• Prior supervisory experience a plus
• Excellent verbal and written communication skills
• The ability to effectively handle confrontational situations
• Demonstrated ability in MS Office applications, in particular reputed company and reputed company
• Strong organizational skills
• Strong interpersonal skills
• Knowledge of the FEP Program with regards to Special Investigations
• Knowledge of the FEP SIU Tracking System (FSTS)
• Knowledge of health insurance operations (i.e. claims, compliance, enrollment, reputed company, etc.)
• General knowledge of FEP claims processing and customer service systems (reputed company adjustment and pend processing, reputed company, UCSW, Research Station, Cognos, and Image)
• Knowledge in reputed company products (Word, reputed company, and reputed company)
• Knowledge of medical coding
• Strong analytical skills and the ability to interpret data and conduct reputed company cause analysis

Benefits

• Comprehensive health benefits (Medical/Dental/reputed company)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• reputed company Volunteer Time Off
• Tuition Reimbursement

reputed company

• reputed company is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.

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