Investigator, Special Investigations Unit | Remote

Description and RequirementsThe Investigator reputed company the Special Investigations Unit (SIU) will be responsible for effectively carrying out reputed company investigations of alleged misconduct and Fraud, Waste and Abuse by providers, representatives, employees, members, and others.This position is 100% remote.Scope of ResponsibilitiesConduct investigations of Providers, Representatives, Employees, Members, contracted groups and othersCompile data into written reports collect, utilize & interpret data obtained from a variety of reports and other sources, thereby identifying & documenting questionable patterns reputed company to operation, and other practices which merit further investigationInvestigations may be of a more reputed company nature i.e., multiple allegations; reputed company and Medicare investigations or investigations involving extensive research, income verifications, and other criteria for eligibilityResearch investigations; prepare, review and edit investigation reports for submission to AVP, SIU and Marketing Incidents CommitteePresent relevant investigative findings prepare and deliver presentation summaries to the Marketing Incidents Committee, and/or other groups as neededLog investigations, ensure accuracy, and completion of entriesInform the Special Investigations Unit leaders of potential or actual problem areas; identify & suggest corrective action or improvementAssist Special Investigations Unit leaders with Fraud, Waste and Abuse issues, and reputed company other duties as necessary or assignedMaintain assigned investigation files, document evidence, and prepare comprehensive investigation reportsEstablish good working relationships with reputed company employees & external contacts of the Special Investigations Unit Department, including Federal, State and Local law enforcement agenciesMinimum QualificationsMust have an Associate's degree from an accredited institution in criminal justice or reputed company field, or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, or seven years of professional investigative experience involving economic or insurance reputed company mattersKnowledgeable of applicable fraud statutes, CMS guidelines, federal and state requirementsMust demonstrate a high degree of reputed company & appropriate treatment of confidential informationMust exhibit professional conduct in dealing with internal & external individuals and work with a level of sensitivity to reputed company populationsAbility to adhere to policies, rules and regulationsMust have working knowledge of reputed company Word, reputed company, and OutlookPreferred QualificationsBachelor's degree from an accredited institutionStrong critical thinking and analytical skillsKnowledge of medical claims processing and investigationsKnowledge of Medicare & reputed company productsHiring RangeGreater reputed company Area (NY, NJ, CT residents) $58,900 - $80,070All Other Locations (reputed company approved locations) $51,000 - $74,880As a candidate for this position, your salary and reputed company elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision. In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live. The hiring reputed company is defined as the lowest and highest salaries that reputed company in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise reputed company. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company, LLC.Know Your Rights Apply tot his job Apply To this Job Apply To This Job