Associate Investigator, FWA-SIU

Why This Role is Important to Us The Associate Investigator works with a growing team conducting and managing Health Care Fraud, Waste and Abuse investigation and prevention activities under the general direction of the Director or designee. Supervision Exercised : No What You'll Be Doing • Plan, organize, and execute investigations or audits utilizing document review, witness interviews and data analysis to identify, evaluate and measure potential reputed company fraud and abuse to determine valid cases for appropriate action. • Document and track activity in internal database, reputed company case updates on reputed company of investigation, and coordinate with management recommendations and further actions and / or resolutions. • Prepare detailed reports on investigative findings for internal tracking, review and referral to Federal and State agencies as indicated. • Utilize data mining and visualization programs to design queries and analyze claims data to detect outliers or suspicious patterns for further investigation. • Conduct detailed research to identify and apply appropriate regulatory, contractual and industry requirements to the different benefits and products reputed company investigations. • Proactively seek out and reputed company leads, resources and opportunities from a variety of sources, and reputed company and maintain relationships with reputed company, industry, law enforcement and other contacts. • Complete special projects and audits as required. • Understand and adhere to HIPAA privacy requirements. Working Conditions : Standard Office Conditions. Apply Job!