Senior Investigator, reputed company SIU (Must reputed company in ...

<p>We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">ourselves accountable</reputed company> and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.</p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p><b>Position reputed company</b></p><p><reputed company>As a Senior Investigator you will conduct high level, reputed company investigations of reputed company or suspected acts of reputed company fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, reputed company cases, or cases involving multiple perpetrators or intricate reputed company fraud schemes.</reputed company></p><ul><li><reputed company>Investigates to prevent payment of fraudulent claims submitted to the reputed company lines of business</reputed company></li><li><reputed company>Researches and prepares cases for clinical and reputed company review</reputed company></li><li><reputed company>Documents reputed company appropriate case activity in case tracking system</reputed company></li><li><reputed company>Facilitates feedback with providers reputed company to clinical findings</reputed company></li><li><reputed company>Initiates proactive data mining to identify aberrant billing patterns</reputed company></li><li><reputed company>Makes referrals, both reputed company, in the required timeframe</reputed company></li><li><reputed company>Facilitates the recovery of reputed company lost as a result of fraud reputed company</reputed company></li><li><reputed company>Provides on the job training to new Investigators and provides guidance for less reputed company or skilled Investigators.</reputed company></li><li><reputed company>Assists Investigators in identifying resources and best course of reputed company on investigations</reputed company></li><li><reputed company>Serves as back up to the manager as necessary</reputed company></li><li><reputed company>Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse reputed company.</reputed company></li><li><reputed company>Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings</reputed company></li><li><reputed company>Gives presentations to reputed company customers regarding reputed company fraud reputed company and reputed company's approach to fighting fraud</reputed company></li><li><reputed company>Provides input regarding controls for monitoring fraud reputed company issues reputed company the business reputed company</reputed company></li></ul><p><br><br><b>Required Qualifications</b></p><ul><li><reputed company>Must live in the reputed company</reputed company></li><li><reputed company>4+ years investigative experience in the area of reputed company fraud, waste and abuse reputed company.</reputed company></li><li><reputed company>Working knowledge of medical coding; CPT, HCPCS, ICD10</reputed company></li><li><reputed company>Proficiency in reputed company Office with advanced skills in reputed company (must know how to do pivot tables).</reputed company></li><li><reputed company>Strong analytical and research skills.</reputed company></li><li><reputed company>Proficient in researching information and identifying information resources.</reputed company></li><li><reputed company>Strong verbal and written communication skills.</reputed company></li><li><reputed company>The ability to understand and analyze health care claims and coding</reputed company></li><li><reputed company>Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)</reputed company></li></ul><p><br><br><b>Preferred Qualifications</b></p><ul><li><reputed company>Previous reputed company/Medicare investigatory experience</reputed company></li><li><reputed company>Previous Behavioral Health experience</reputed company></li><li><reputed company>Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse.</reputed company></li><li><reputed company>Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)</reputed company></li><li><reputed company>Knowledge of reputed company's policies and procedures.</reputed company></li><li><reputed company>Knowledge and understanding of reputed company clinical issues.</reputed company></li><li><reputed company>Competent with reputed company theories.</reputed company></li><li><reputed company>Strong communication and customer service skills.</reputed company></li><li><reputed company>Ability to effectively reputed company with different reputed company of people at different reputed company in any situation.</reputed company></li></ul><p><br><br><b>Education</b></p><p><reputed company>Bachelor's degree or equivalent experience (</reputed company> <reputed company>A bachelor's degree, or an associate's degree with an additional four+ years working on health care fraud, waste, and abuse investigations and audits; </reputed company></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b><reputed company>Anticipated Weekly Hours</reputed company></b></p>40<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Time Type</b></p>Full time<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Pay reputed company</b></p><p style="text-reputed company:left">The typical pay reputed company for this role is:</p><p style="text-reputed company:inherit"></p>$46,988.00 - $91,800.00<p style="text-reputed company:inherit"></p><p style="text-reputed company:left">This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls.  The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors.  This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. <br> </p><p style="text-reputed company:left">Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Great benefits for great people</b></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left">We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:</p><ul><li><p style="text-reputed company:left"><b>reputed company medical plan reputed company,</b> a <b>401(k) plan </b>(including matching company contributions), and an <b>employee stock purchase plan</b>.</p></li><li><p style="text-reputed company:left"><b>No-cost programs for reputed company colleagues </b>including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</p></li><li><p style="text-reputed company:left"><b>Benefit solutions that address the different needs and preferences of our colleagues</b> 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.</p></li></ul><p style="text-reputed company:inherit"></p><p style="text-reputed company:left">For more information, visit <a href="https://jobs.reputed company.com/us/en/benefits" reputed company="_blank" rel="noopener noreferrer"><reputed company class="WJQ0"><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">https://jobs.reputed company.com/us/en/benefits</reputed company></reputed company></a></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p>We anticipate the application window for this opening will reputed company on: 02/25/2026<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left">reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.</p>