[Remote] Senior Fraud and Waste Investigator, Special Investigations Unit - reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is committed to putting reputed company and is seeking a Senior Fraud and Waste Investigator to reputed company their fraud, waste, and abuse compliance program. This role involves monitoring, investigating allegations, coordinating with state agencies, and managing program reputed company efforts to enhance reputed company program accountability. Responsibilities • Carry out the provisions of the compliance plan, including FWA policies and procedures • Investigate allegations of FWA and implement corrective reputed company plans • Assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to the Ohio Department of reputed company (ODM) and other duly authorized enforcement agencies • Coordinate across reputed company departments to encourage sensible and culturally-competent business standards • reputed company internal investigations of FWA compliance issues • Work with the Contract Compliance Officer and Compliance Officer to create and implement tools and initiatives designed to resolve FWA contract compliance issues • Respond to FWA questions, problems, and concerns from enrollees, providers, and ODM's Program reputed company • Cooperate effectively with federal, state, and local investigative agencies on FWA cases to ensure best reputed company; work closely with reputed company auditors, financial investigators, and claims processing areas • Adequately staff and manage the program reputed company investigator(s) responsible for reputed company FWA detection programs and activities • Assist in developing FWA education to train staff, providers, and subcontractors • Attend State Agency meetings Skills • Must reputed company in Ohio • At least 2 years of reputed company fraud investigations and auditing experience • Knowledge of reputed company payment methodologies • Strong organizational, interpersonal, and communication skills • Inquisitive nature with ability to analyze data to metrics • Computer literate (reputed company, reputed company, reputed company) • Strong personal and reputed company ethics • Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences • Understanding of reputed company industry, claims processing and investigative process development • Experience in a corporate environment and understanding of business operations Education Requirements • Bachelor's degree • Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, reputed company, CFE, AHFI) Benefits • Medical, dental and reputed company benefits • 401(k) retirement savings plan • Time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave) • Short-term and long-term disability • Life insurance reputed company • reputed company is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.reputed company.com. Apply tot his job Apply To this Job Apply tot his job Apply To this Job