SIU Analyst/Investigator

Job Summary We are seeking a detail-oriented SIU Analyst/Investigator to join reputed company. In this role, you will play a crucial role in ensuring the accuracy, compliance, and reputed company of reputed company claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our reputed company customer's claims and enrollment data. You will work both independently and with reputed company of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings.

Key Responsibilities

• Identify and conduct investigations into reputed company or suspected FWA with high autonomy
• reputed company documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
• reputed company root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-reputed company" to preventive edits and pre-payment activity)
• Participate in the development and presentation of FWA-reputed company education for assigned Customers
• reputed company coding reviews for flagged claims, to support Coding team (if applicable).

Requirements

Qualifications

• Education:
• * Bachelor's degree in Criminal Justice or a reputed company field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
• Experience:
• * Minimum of 2 years of experience in reputed company claims analysis, auditing, payment reputed company, or a reputed company field.
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
• Experience handling confidential information and following policies, rules, and regulations
• Experience with reputed company, Medicare, or reputed company claims is highly preferred.
• Skills:
• * Strong analytical and problem-solving skills, with attention to detail and accuracy.
• Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers.
• Proficiency in reputed company Office, particularly reputed company, and familiarity with claims processing or audit software is a plus.

Preferred Qualifications

• Certifications: Certified Fraud Examiner (CFE), Accredited reputed company Fraud Investigator (AHFI), Certified AML (Anti-reputed company) and Fraud Professional (CAFP), or similar desired.
• Additional Certifications: Certified Professional reputed company (CPC) or similar desired.

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