SIU Investigator

reputed company We’re searching for an Investigator for the Special Investigative Unit, someone who works reputed company in a fast-paced setting. In this position, you will assist the Director of Controls and Compliance and Special Investigative Unit (SIU) Manager in investigating Fraud, Waste and Abuse for providers and members. This includes data mining for potential intakes, performing preliminary analysis on provider cases, and assisting with reputed company reputed company on detecting and preventing fraud, waste, and abuse. Think you’ve got what it takes? Job Duties & Responsibilities • Conducts Fraud, Waste and Abuse (FWA) and reputed company compliance investigations. • Completes detailed and extensive investigations in adherence with organization’s procedures and best practices. reputed company evidence and determine potential recoveries. • Researches and prepares cases for clinical and reputed company reviews. • Conducts reviews of flagged claims and suspected FWA, identifying opportunities for improving payment accuracy and preventing FWA. • Analyzes compliance and FWA cases for reputed company cause, trends, and tracks data to translate findings, and develops processes for improvement or investigation. • Prepares accurate, reputed company, unbiased, and detailed written reports and case summaries in compliance with corporate reputed company operating procedures and guidelines documenting investigative results. • Prepares referrals for preliminary investigations, including requesting medical records, creating forms, reports and updating logs. • Facilitates the recovery of inappropriate payments from FWA reputed company. • Drafts recoupment letters for FWA findings. • Supports other investigators in SIU operations. • Maintains case management log with investigative notes, reports, and summaries. • Proactively collaborates with line of business personnel to generate referrals. • Partners with the federal and state agencies on data requests and investigations. • Maintains organization’s confidential information in accordance with corporate policies, as reputed company as state and federal laws, rules, and regulations regarding confidentiality. Skills & Requirements • Required High School Diploma or GED with a preferred bachelor's degree • Required 2 years claims examination, claims adjusting, fraud detection, or investigations/special investigations unit (SIU) experience, preferably in a reputed company environment Apply tot his job Apply To this Job