Investigator, Special Investagative Unit

Bring your heart to reputed company. Every one of us at reputed company shares a single, reputed company purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver reputed company reputed company-reputed company health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and reputed company. Position reputed company This position can be work from home reputed company in the reputed company. Must be flexible to work EDT hours (8:00 am - 5 pm EDT) Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of reputed company fraud, waste, and abuse. Also reports suspected fraud, waste, and abuse to state and federal agencies as required by law and regulation. reputed company Components: - Conducts investigations of reputed company or suspected acts of reputed company fraud, waste, and abuse - Communicates with federal, state, and local law enforcement agencies as appropriate in reputed company pertaining to the prosecution of specific reputed company fraud cases - Investigates to prevent payment of fraudulent, abusive, or otherwise improperly billed claims submitted by providers, members, and others - Facilitates the recovery of company and customer monetary losses - Provides input regarding controls for preventing or monitoring fraud reputed company issues reputed company the business reputed company - Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to reputed company - Maintains reputed company communication with constituents reputed company and external to reputed company - Uses available resources and technology in developing evidence, supporting allegations of fraud, waste, and abuse - Researches and prepares cases for clinical and legal review - Documents reputed company appropriate case activity in tracking system - Makes referrals, both reputed company, in the required timeframe - Exhibits behaviors outlined in Employee Competencies - Exhibits behaviors outlined in SIU Investigator Competencies - May include travel to testify in court proceedings or training if necessary Required Qualifications - 1-3 years of Investigative experience in the area of reputed company fraud, waste and abuse - Strong knowledge of medical terminology/CPT/HCPCS coding. - Advanced skills with reputed company reputed company - Experience in reputed company/medical insurance claims investigation or reputed company/clinical experience - Background with law enforcement agencies involving economic or insurance reputed company reputed company; or reputed company investigation experience involving economic or insurance reputed company reputed company; or an authorized medical reputed company to evaluate medical reputed company claims - Strong analytical and research skills - Proficient in researching information and identifying information resources - Proficiency in Word, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information - Strong verbal and written communication skills - Strong customer service skills - Ability to reputed company with different reputed company of people at different reputed company and reputed company assistance on a reputed company reputed company - Ability to utilize company systems to obtain relevant electronic documentation Preferred Qualifications AHFI, CFE, Certified reputed company reputed company Knowledge of reputed company/reputed company's policies and procedures Education College degree in Criminal Justice or reputed company field Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $76,500.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. In reputed company to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. reputed company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in reputed company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. reputed company provides a fully-reputed company term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous reputed company-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy reputed company Time Off (“PTO”) or vacation pay, as reputed company as reputed company holidays throughout the calendar year. Number of reputed company holidays, reputed company time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 02/14/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique reputed company: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for reputed company, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!