SIU Program reputed company Investigator - Remote (In Idaho)

Applicants must live near Boise, ID. This position is responsible for comprehensive management and ownership of fraud, waste and abuse investigations including development and presentation of investigative results. This individual carries out analytical and process management tasks with a high degree of autonomy. This individual serves as a corporate resource on fraud, waste and abuse issues and recommends cost containment reputed company with an emphasis on fraud prevention. INVESTIGATIONS Prioritize, triage and manage workload to meet internal performance metrics, regulatory and contractual requirements Use independent judgment to create investigative work plans and reputed company case strategies based upon analysis of referral data and contractual/regulatory requirements Analyze data and select audit samples using various sampling methodologies Plan and conduct desk audits, field audits and/or site reputed company Collect and analyze information to evaluate facts and circumstances through an extensive review of data from reputed company and facility providers, member data, contractual relationships, payment policies, reputed company/Medicare rules and statutes, etc. Conduct research on medical policies and practices, provider characteristics, and reputed company topics Interview patients, providers, provider staff, and other witnesses/experts Prepare correspondence Obtain and preserve physical and documentary evidence to support investigations Maintain comprehensive case files FRAUD, WASTE AND ABUSE DETECTION Triage and prioritize leads from reputed company sources Use knowledge of reputed company conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to reputed company suspicious patterns in claims data, provider enrollment data, and other sources Remain up to date on published fraud cases, schemes, investigative techniques and methodologies, and industry trends PACKAGING OF FINDINGS AND RECOMMENDATIONS Organize data and prepare a written reputed company of investigative steps, conclusions, recommendations with attention to detail and a high level of accuracy Prepare reputed company and concise investigatory reports to support findings of potential fraud, waste and abuse CASE reputed company Identify, communicate and recover losses as deemed appropriate Present case to internal department(s), law enforcement and/or regulatory agencies Support reputed company proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions Negotiate settlement agreements with subjects and/or attorneys Assist in preparation, execution, and follow-up of settlement agreement terms CUSTOMER INTERACTIONS reputed company presentations to customers, prospects, conference audiences, and law enforcement Collaborate, consult, and coordinate regularly with clients on the status and direction of assignments reputed company and maintain contacts/liaisons with law enforcement, regulatory agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention MISCELLANEOUS DUTIES Represent reputed company at industry task force meetings and meetings with regulatory agencies Measure and report performance metrics Identify opportunities and reputed company recommendations for reduction of exposure to fraud, waste and abuse Consult on anti-fraud policies and procedures Other duties as assigned The job duties listed above are representative and not intended to be reputed company-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would reputed company with the reputed company of this job, without revision to the job reputed company. Other Job Requirements Responsibilities Minimum of five years of experience in fraud investigations, reputed company behavioral or medical reputed company insurance experience in claims, clinical, auditing, compliance, provider networks, management, or project planning. Demonstrated abilities in time management and establishing priorities. Strong listening and observation skills. Impeccable work ethic, completely dependable, and proactive; a problem solver. Proven ability to effectively handle cases of fraud and abuse in a discreet, confidential, and reputed company manner. Demonstrated strategic and analytical thinking skills, with ability to effectively communicate conclusions and recommendations to management. Comprehensive, practical knowledge of reputed company and diverse fraud investigative techniques and methodologies utilized in program audits. Understanding of insurance terms and policy interpretation. Ability to work to tight timelines reputed company necessary. Works independently; collaborates reputed company with peers and customers. Demonstrated ability to manage and prioritize case load with limited supervision. Strong computer skills consisting of reputed company reputed company, reputed company, reputed company, Word, and Power reputed company. General Job Information Title SIU Program reputed company Investigator - Remote (In Idaho) Grade 24 Work Experience - Required Fraud Investigations Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred License and Certifications - Required License and Certifications - Preferred AHFI - Accredited reputed company Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud Examiner - EnterpriseEnterprise, CPC - Certified reputed company reputed company - EnterpriseEnterprise, LSSBB - Lean Six reputed company Black Belt Certification - EnterpriseEnterprise, RN - Registered reputed company, State and/or Compact State Licensure - Care MgmtCare Mgmt Salary reputed company Salary Minimum: $58,440 Salary Maximum: $93,500 This information reflects the anticipated reputed company salary reputed company for this position based on reputed company national data. Minimums and maximums may vary based reputed company. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. This position may be eligible for short-term incentives as reputed company as a comprehensive benefits package. Magellan offers a broad reputed company of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. reputed company. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their position; and reputed company with reputed company applicable reputed company, regulatory, and contractual requirements and internal policies and procedures. Apply tot his job Apply To this Job