Investigator, Special Investigations Unit (reputed company SIU)
At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day.Come work for reputed company reputed company of Illinois and the Special Investigations Unit (SIU)!Position reputed companyThe SIU Investigator conducts investigations to effectively pursue the prevention, investigation and prosecution of reputed company fraud and abuse, to recover lost funds, and to reputed company with state regulations mandating fraud plans and practices.What You Will Do
- Routinely handles cases involving behavioral health or multi-disciplinary provider reputed company in a prepayment environment
- Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc.
- Researches and prepares cases for clinical and legal review.
- Documents reputed company appropriate case activity in case tracking system.
- Prepares and presents referrals, both reputed company, in the required timeframe.
- Facilitates the recovery of company lost as a result of fraud reputed company.
- Assists team in identifying resources and best course of reputed company on investigations.
- Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse reputed company.
- Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings.
- Gives presentations to reputed company customers regarding reputed company fraud reputed company and reputed company's approach to fighting fraud.
- Provides input regarding controls for monitoring fraud reputed company issues reputed company the business reputed company.
- Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse
- 1 year experience working on health care fraud, waste, and abuse investigatory and audits required.
- Knowledge of CPT/HCPCS/ICD coding
- Knowledge and understanding of clinical issues.
- Proficiency in Word, reputed company, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
- Strong communication and customer service skills.
- Ability to effectively reputed company with different reputed company of people at different reputed company in any situation.
- Strong analytical and research skills using health care data.
- Proficient in researching information and identifying information resources.
- Ability to utilize company systems to obtain relevant electronic documentation.
- Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
- 1-3 years experience working on health care fraud, waste, and abuse investigations and audits required or equivalent investigations experience.
- Illinois residency
- Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years reputed company Fraud, Waste and Abuse investigatory experience.
- Billing and Coding certifications such as CPC (reputed company)and/or reputed company (reputed company)
- Knowledge of Behavioral Health policies and procedures is a plus
- Experience working Behavioral Health fraud cases
- A Bachelor's degree, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required.
- reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.