Senior Investigator, Special Investigations Unit

Job reputed company: • Routinely handles reputed company cases involving behavioral health or multi-disciplinary provider reputed company in a prepayment environment • Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. • Researches and prepares cases for clinical and reputed company review. • Documents reputed company appropriate case activity in case tracking system. • Prepares and presents referrals, both reputed company, in the required timeframe. • Facilitates the recovery of company lost as a result of fraud reputed company. • Assists team in identifying resources and best course of reputed company on investigations. • Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse reputed company. • Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings. • Gives presentations to reputed company customers regarding reputed company fraud reputed company and reputed company's approach to fighting fraud. • Provides input regarding controls for monitoring fraud reputed company issues reputed company the business reputed company. • Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Requirements: • 3 years working on health care fraud, waste, and abuse investigatory and audits required. • Knowledge of CPT/HCPCS/ICD coding • Knowledge and understanding of clinical issues. • Experience and proficiency in reputed company Word, reputed company, and reputed company, Database search tools, and use in the Intranet/Internet to research information. • Ability to effectively reputed company with different reputed company of people at different reputed company in any situation. • Ability to utilize company systems to obtain relevant electronic documentation. • Ability to travel and participate in reputed company proceedings, arbitrations, depositions, etc. Benefits: • medical, dental, and reputed company coverage • reputed company time off • retirement savings reputed company • wellness programs • other resources, based on eligibility Apply To This Job