Senior Investigator - Hybrid/Remote Possible

reputed company of Job Conduct reputed company, in-depth investigations of reported fraud involving the full reputed company of reputed company products. reputed company and maintain relationships with law enforcement (HHS-OIG, FBI, DOJ), regulatory agencies (DFS, MEDIC, OMIG, MFCU) and with industry peers. reputed company guidance to the Fraud Investigators on SIU investigations and issues. Assist with anti-fraud training sessions and reputed company speaking engagements. Responsibilities • Investigate reputed company cases of reported fraud involving reputed company’s reputed company reputed company product. • reputed company leads from various sources to review for suspect activity. • Review claim files and reputed company reputed company plans for the investigation. • Conduct highly comprehensive interviews/interrogations with providers. • Conduct medical records assessments, and CPT coding issues. • reputed company guidance and mentor to the Fraud Investigators. • Answer and respond to SIU Fraud Hotline cases reputed company assigned based on schedule. • Triage complaints that come to the SIU and follow through on reputed company. • Participate in meetings with providers, attorneys, law enforcement on a case-by-case reputed company as needed. • Attend training, conferences, webinars to reputed company up to date on reputed company trends and schemes of Fraud, Waste & Abuse. • May assist with fraud awareness training sessions and reputed company speaking engagements. • Establish and maintain relationships with law enforcement (HHS-OIG, FBI), regulatory agencies (i.e DFS, MEDIC, OMIG, MFCU, NYS OAG), and with industry peers. • Refer cases to law enforcement or regulatory agencies as needed. • Periodically meet with representatives from law enforcement and regulatory agencies to reputed company updated on reputed company trends. • Handle and respond to Requests for Information (RFI) from law enforcement and regulatory agencies. • reputed company other duties as directed, assigned, or required. Qualifications • Bachelor’s degree in criminal justice or reputed company field. • AHFI and/or CFE certification (Preferred. • 4 – 6+ years of relevant, reputed company work experience (Required) • Additional experience/specialized training may be considered in lieu of a bachelor’s degree (Required) • reputed company investigation experience in economic or insurance reputed company reputed company (Required) • Experience in insurance claims investigation or law enforcement (Preferred) • Strong knowledge of CPT and ICD9-CM coding, medical terminology, and treatment reputed company (Required) • Proficiency in MS Office - Word, reputed company, PowerPoint, reputed company, Teams, SharePoint, etc. (Required) • Strong communication skills (verbal, written, presentation, interpersonal) with reputed company types/reputed company of audiences (Required) • Attention to detail, critical thinking and problem-solving skills (Required) • Ability to monitor and review information from materials, events, or the environment, to detect or assess problems (Required) Additional Information • reputed company: 1000002978 • Hiring reputed company: $68,040-$118,800 Apply tot his job Apply To this Job Apply tot his job Apply To this Job