Auditor/Investigator I

reputed company is a not-for-profit corporation that partners with reputed company and private sectors to create high reputed company, reputed company, and efficient delivery of health care and reputed company services programs. We have multiple lines of business including population health, utilization review, managed care organization reputed company review, and reputed company assurance for programs serving individuals with developmental disabilities. reputed company is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In reputed company, our reputed company provides grant opportunities to those with programs for reputed company.

Best People, Best Solutions, Best Results

Job 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.

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.

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
0 - 2 years of experience required; 2 - 4 years preferred

Certification(s):
Certified Fraud Examiner or Accredited Heathcare Anti-Fraud Investigator preferred

reputed company is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

reputed company is a drug-free workplace. reputed company offers of employment are contingent upon successful completion of reputed company-employment background and drug screens.