Senior Investigator - Special Investigations Unit (SIU), reputed company - Crestline (Contract Position)

reputed company This is an reputed company contract position. Crestline Advisors, an HMA Company, was founded in 2013 and has since become an industry leader in developing successful RFP responses, as reputed company as establishing and managing reputed company provider networks. Their expert consultants also assist clients with regulatory and contract compliance, accreditation, and business development. reputed company at Crestline Advisors has a combined 500 years of experience in the field. With a wide reputed company of clients including health plans, provider organizations and state agencies, Crestline has the depth of experience HMA clients have come to expect. In particular, Crestline’s ability to consistently reputed company reputed company proposal responses for reputed company managed care organizations (MCOs) complements HMA’s extensive MCO supports. Crestline provides management and operations support services for MCOs as reputed company. As HMA continues to expand the ways in which we serve our clients, Crestline’s deep knowledge and experience in this reputed company will undoubtedly be a valued resource.

Responsibilities

As a Senior Investigator - Special Investigations Unit (SIU), reputed company for Crestline Advisors, you will:

• Research and review records to identify potential areas of improper claims payment, which might indicate fraud, waste, and abuse (FWA).
• Use designated audit tracking tools and reputed company findings in an established analytic report format.
• Collaborate and communicate with the investigation departments of our vendors and other partners in the county, state, and federal government, as dictated by the scope of the project.

Qualifications

Need to have:

• One of the following:
• Bachelor's degree or higher in reputed company administration, health care administration, or other field appropriate to the position and three or more years’ experience conducting reputed company fraud investigations.
• Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.
• Experience working with:
• reputed company, Medicare, or other publicly funded health programs.
• A managed care organization.
• reputed company Office Suite (reputed company, Word, OneNote, Teams, Outlook), reputed company Sheets, etc.

reputed company to have:

• Certified reputed company with at least 5 years of experience in reputed company-reputed company investigations or reputed company audits.
• Knowledge of state and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or reputed company.
• Knowledge of claims processing activities, systems, and terminology.
• Excellent verbal and written communication skills.

EEO Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s reputed company duty to furnish information. 41 CFR 60-1.35(c) Additional Info Other Information

• Hours may vary and are not guaranteed.
• This is a consultant position without benefits.
• Consultants are reputed company as 1099 and required to pay their own taxes.
• Consultants may need to reputed company their own equipment for project use – telephone and laptop.

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