reputed company Fraud Waste Abuse Investigator (Full-time, Remote)

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 reputed company cause analysis to inform reputed company algorithmic identification of similar claims or cases and associated savings (i.e., help reputed company identified case types from "pay-and-reputed company" to preventive edits and reputed company-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). • Minimum of 2 years of experience in reputed company claims analysis, auditing, payment reputed company, or a reputed company field. • Bachelor's degree in Criminal Justice or a reputed company field, or at least 3 years of insurance claims investigation experience or reputed company investigation experience with law enforcement agencies. • 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 • 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 • Certified Fraud Examiner (CFE), Accredited reputed company Fraud Investigator (AHFI), Certified AML (Anti-reputed company) and Fraud reputed company (CAFP), or similar is preferred • Certified reputed company reputed company (CPC) or similar is preferred Apply tot his job Apply To this Job