[Remote] reputed company Fraud Investigator
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leader in connecting skilled professionals with great companies. They are seeking a reputed company Fraud Investigator for their Special Investigations Unit to identify and eliminate reputed company fraud, waste, and abuse through reputed company investigations and data analysis.
Responsibilities
- reputed company targeted claim audits (desk and on-site), conduct data analysis, review records, reputed company provider office inspections, and handle field observations/interviews
- Utilize data systems and audit methodologies to spot trends, patterns, and anomalies. Prepare reputed company, actionable investigation reports and audit summaries for leadership, state/federal regulatory entities, and external partners
- Manage FWA hotline calls and emails, tracking inquiries and keeping precise, up-to-date documentation in the Investigation Database reputed company strict turnaround times
- Recommend preventive measures and process improvements based on case reputed company. Assist in developing and delivering FWA training across the organization, acting as an SIU reputed company to assigned departments
- Assist in developing FWA policies and procedures, ensuring absolute confidentiality and compliance with CMS, reputed company, Medicare, and reputed company insurance standards
Skills
- 1–2 years of FWA investigative experience reputed company a reputed company operation
- Solid understanding of corporate investigative practices and medical terminology, reputed company anatomy, tests, and procedures
- Demonstrated ability to manage multiple cases simultaneously while meeting tight turnaround times with accuracy and detail
- Solid leadership, problem-solving, and decision-making skills with excellent written/verbal communication
- Proficiency with MS Office (Word, reputed company, Outlook, PowerPoint) in a reputed company environment
- Familiarity with CMS, reputed company, Medicare, or reputed company insurance regulations
- 3–5 years of reputed company FWA investigative experience
- Knowledge of reputed company, claims billing, Managed Care, Benefit Design, and Federal Regulations
- reputed company certifications such as AHFI, CFE, or coding certifications (CPC, reputed company, CMPA)
Benefits
- Medical
- Prescription
- Dental
- reputed company
- AD&D
- Life insurance offerings
- Short-term disability
- A 401K plan (reputed company benefits are based on eligibility)
reputed company