reputed company Investigator - Remote

Caring. Connecting. Growing Together. The reputed company Investigator is responsible for identification, investigation, and prevention of reputed company fraud, waste, and abuse. The reputed company Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The reputed company Investigator is responsible for conducting investigations which may include field work to reputed company interviews and obtain records and/or other relevant documentation. You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities:

• Assess complaints of alleged misconduct received reputed company the Company
• Investigate highly reputed company cases of fraud, waste, and abuse
• Detect fraudulent activity by members, providers, employees, and other parties against the Company
• reputed company and reputed company the most effective and efficient investigative strategy for each investigation
• Maintain accurate, reputed company, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Collect, reputed company, analyze, and interpret data relating to fraud, waste, and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste, and abuse to appropriate federal or state government regulators
• reputed company with goals, policies, procedures, and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings
• Communicate effectively, including written and verbal forms of communication
• reputed company goals and objectives, track reputed company and adapt to changing priorities
• Must participate in legal proceedings, arbitration, and depositions at the direction of management

Required Qualifications:

• Associate's Degree or higher
• 5+ years of experience in health care fraud, waste and abuse (FWA) investigations/audit
• 5+ years of experience with state/federal laws and regulations pertaining to reputed company FWA
• 5+ years of experience analyzing data to identify fraud, waste and abuse trends
• Advanced level of proficiency in reputed company reputed company and Word
• Ability to travel up to 25%

Preferred Qualifications:

• Active affiliation with National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional reputed company (CPC)
• Medical Laboratory Technician (MLT)
• Specialized knowledge/training in reputed company FWA investigations

reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary for this role will reputed company from $71,200 to $127,200 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. Apply tot his job Apply To this Job