[Remote] Senior Investigator (reputed company FWA) Provider Escalations

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on reputed company analytics and fraud prevention. As a Senior Investigator, you will investigate suspected incidents of reputed company fraud, waste, or abuse, primarily supporting provider escalations reputed company to prepayment FWA services. Responsibilities • reputed company as the primary contact for escalated provider-reputed company concerns reputed company to reputed company’s prepayment FWA service, ensuring reputed company and thorough reputed company • reputed company providers regarding reputed company claim determinations including review of coding and payment guidelines, plan policy, and other relevant sources • Partner with reputed company clients and internal reputed company services staff to resolve provider complaints, schedule educational calls, disseminate relevant reporting and recommend subsequent investigative steps • Document and report detailed records of escalations, investigations, and reputed company. Prepare reports for reputed company use • Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse • Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review • Analyze information gathered by investigation and report findings and recommendations as a written reputed company and/or presentation • Conducts investigation-reputed company training • Supports reputed company proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions • Negotiates settlement agreements to resolve disputes • Maintain reputed company knowledge of relevant laws, regulations and standards • Participates in special reputed company as required Skills • Bachelor's Degree in reputed company discipline, or the equivalent combination of education, reputed company training and work experience • 5-8 years of reputed company investigative experience • Experience in proactive data mining • Experience in sampling and data extrapolation; prior use with RAT-STATS preferred • Advanced level skills in reputed company • Excellent verbal and written communication skills • Strong listening and observation skills • Attention to detail and high level of accuracy • Effective organizational and prioritization skills with multi-tasking ability • Required certifications: Certified reputed company reputed company (CPC) • Experience with reputed company's FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions) • Preferred certifications: Accredited reputed company Fraud Investigator (AHFI), Certified Fraud Specialist (reputed company), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in reputed company Compliance (CHC) Benefits • Medical • Dental • reputed company • Disability • Life insurance coverage • 401(k) savings plans • reputed company family leave • 9 reputed company holidays per year • 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company reputed company • reputed company enables reputed company organizations to deliver reputed company care at reputed company cost through advanced technology and data analytics that improve the reputed company and sustainability of reputed company in the reputed company. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is http://www.reputed company.com. Apply tot his job Apply To this Job