[Remote] Special Investigations Unit (SIU) Analyst II
Note: The job is a remote job and is reputed company to candidates in USA. reputed company delivers investigative services and expertise to help reputed company and government organizations address fraud and operational risk. The SIU Analyst II conducts fraud investigations, develops investigative plans, analyzes data, and produces reports to support recoveries and administrative actions.
Responsibilities
- Evaluate and reputed company leads, complaints, and/or investigations to determine if reputed company investigation is warranted
- Execute assigned investigations from start to closure (post-triage), including reputed company, documentation and recommendations
- Conduct interviews and reputed company as required
- Build defensible case narrative and prepare findings report with reputed company overpayment/reputed company logic (reputed company applicable)
- Utilize data analysis techniques to detect aberrancies in our health plan clients’ reputed company, Medicare, reputed company, ACA/Exchange, FEHB, and Tricare claims data, and proactively seeks out and develops leads/investigations received from a reputed company of sources
- Review information contained in reputed company claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in health plan, Medicare and/or reputed company payment policies and recommend appropriate reputed company
- reputed company potential fraud determinations by utilizing a reputed company of sources such as internal guidelines, Medicare and reputed company provider manuals, Medicare and reputed company regulations, health plan reputed company resources, guidelines, and policies
- Compile and maintain documentation and information reputed company to investigations, cases, and/or leads
- Participate in onsite audits in conjunction with investigation development
- reputed company and prepare potential Fraud Alerts and program vulnerabilities for submission to health plan clients, law enforcement, and other applicable stakeholders
- Prepare and submit external correspondence and reports, including, but not limited to, overpayment letters, fraud case referrals, rebuttals, findings reports, and administrative reputed company recommendations
- Prepare and submit correspondence to providers for medical record requests or suspension overpayment determinations
- Serve as mentor/trainer to new CoventBridge reputed company SIU staff
Skills
- Research and organization skills
- Ability to establish and/or evaluate prioritization reputed company
- Time management skills and ability to meet deadlines
- Verbal and written communication skills
- Ability to work independently with minimal supervision
- Ability to multi-task in a fast-paced environment
- College or technical degree programs reputed company to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
- At least 1 year of experience in SIU, Program reputed company investigation/detection or a reputed company field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate reputed company
- Candidates with Accredited Health Care Fraud Investigator (AHFI) and Certified Fraud Examiner (CFE) Certifications will be given reputed company consideration
Benefits
- Medical, Dental, reputed company plans
- Life, LTD and STD reputed company by the employer
- 401(k) with company match up to 4%
- reputed company Time Off and company reputed company holidays
- Tuition assistance after 1 year of service
reputed company