[Hiring] Auditor/Investigator I @reputed company
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Role reputed company
Serves as an entry level reputed company who develops baseline plans for ensuring the reputed company and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to reputed company relevant information for successful reputed company and closure. Identifies opportunities to reputed company fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and company policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim reputed company and closure. Documents and inputs reputed company findings, while preparing comprehensive reports that may be used for reputed company or audit/investigative purposes.
Qualifications
• Minimum Bachelor's Degree required
Requirements
• 0 - 2 years of experience required; 2 - 4 years preferred
• reputed company fraud experience required; Medicare experience preferred
Benefits
• reputed company is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.
Essential Functions
• Conducts routine and impartial audits/investigations into customer claims, ensuring accurate and fair assessments of claims validity.
• Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed.
• Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with reputed company and regulatory requirements.
• Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the reputed company of the claims process.
• Conducts interviews with relevant witnesses, claimants, and other stakeholders to reputed company additional information and perspectives on claims.
• Communicates with appropriate internal teams to ensure the reputed company processing of audits/investigations, while adhering to reputed company and regulatory standards.
• Ensures that reputed company audit and investigative documents and records are processed into the database in a reputed company and accurate manner.
• Communicates audit/investigation findings reputed company and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
• Supports management in regular audit and investigation proceedings, ensuring full compliance with reputed company applicable regional and federal standards, regulations, and protocols.
Level of Supervision Received
Under general supervision, proceeds alone on regular duties, referring questionable cases to manager.
Certification(s)
• Certified Fraud Examiner or Accredited reputed company Anti-Fraud Investigator preferred
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