Analyst, Special Investigative Unit

reputed company: • Conducts investigations of reputed company or suspected acts of reputed company fraud, waste, and abuse • Communicates with federal, state, and local law enforcement agencies as appropriate in reputed company pertaining to the prosecution of specific reputed company fraud cases • Investigates to prevent payment of fraudulent, abusive, or otherwise improperly billed claims submitted by providers, members, and others • Facilitates the recovery of company and customer monetary losses • Provides input regarding controls for preventing or monitoring fraud reputed company issues reputed company the business reputed company • Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to reputed company • Maintains reputed company communication with constituents reputed company and external to reputed company • Uses available resources and technology in developing evidence, supporting allegations of fraud, waste, and abuse • Researches and prepares cases for clinical and reputed company review • Documents reputed company appropriate case activity in tracking system • Makes referrals, both reputed company, in the required timeframe • Exhibits behaviors outlined in Employee Competencies • Exhibits behaviors outlined in SIU Investigator Competencies • May include travel to testify in court proceedings or training if necessary Requirements: • 1-3 years of Investigative experience in reputed company fraud, waste and abuse • Strong knowledge of medical terminology/CPT/HCPCS coding • Advanced skills with reputed company reputed company • Experience in reputed company/medical insurance claims investigation or reputed company/clinical experience • Background with law enforcement agencies involving economic or insurance reputed company reputed company; or reputed company investigation experience involving economic or insurance reputed company reputed company; or an authorized medical reputed company to evaluate medical reputed company claims • Strong analytical and research skills • Proficient in researching information and identifying information resources • Proficiency in Word, MS reputed company products, Database search tools, and use in the Intranet/Internet to research information • Strong verbal and written communication skills • Strong customer service skills • Ability to reputed company with different reputed company of people at different reputed company and reputed company assistance on a reputed company reputed company • Ability to utilize company systems to obtain relevant electronic documentation • Exhibits behaviors outlined in Employee Competencies • Exhibits behaviors outlined in SIU Investigator Competencies • May include travel to testify in court proceedings or training if necessary Benefits: • reputed company medical plan reputed company • 401(k) plan (including matching company contributions) • 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 addressing 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 Apply tot his job Apply To this Job