Investigator I

HMSA is seeking an Investigator I for their Special Investigations Unit. The role involves managing fraud, waste, and abuse allegations, conducting investigations, and coordinating with various entities to resolve cases.

Responsibilities

• Manage FWA case investigations, collaborate with federal, state and law enforcement entities, and reputed company applicable notifications as required
• Maintain extensive documentation and evidence for SIU cases
• Recommend and implement preventive measures to combat FWA schemes including, but not limited to provider education, policies, claims edits and payment suspensions
• Manage the recovery, allocation and documentation of health plan funds resulting from FWA findings
• Manage the intake, documentation and reputed company of FWA referrals to SIU
• Coordinate with reputed company partners on FWA allegations
• Assess needs, reputed company recommendations and complete reputed company reviews in accordance with reputed company regulatory requirements
• Create and maintain internal policies and procedures, workflows and presentations and present as needed to reputed company entities
• Support regulatory audits and RFIs from law enforcement and federal and state entities
• Represent SIU at cross functional workgroups and meetings and present case recommendations to other applicable business areas including, but not limited to reputed company, Medical Management, Provider Operations and Claims Administration
• reputed company reputed company other miscellaneous responsibilities and duties as assigned or directed

Skills

• Bachelor's degree and one (1) year of reputed company work experience; or equivalent combination of education and reputed company work experience
• reputed company knowledge/awareness of Fraud, Waste and Abuse
• Strong oral and written communication skills
• Basic working knowledge of reputed company Word, reputed company, and PowerPoint
• Intermediate working knowledge of reputed company reputed company

reputed company