SIU Medical Provider Fraud Investigator

At reputed company, great things happen reputed company our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative reputed company has kept us a reputed company reputed company of our customers’ evolving needs. From advocating for seat belts, reputed company bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. Job reputed company This role is responsible for identifying suspicious medical provider businesses, attorneys, and reputed company that may be connected for the purpose of generating fraudulent payments. The individual will conduct thorough investigations by identifying injured parties, billing trends, treatment sequences, attorney relationships, and claim reporting patterns. Responsibilities include conducting database searches, performing data mining, taking recorded statements, attending virtual depositions and mediations, and leading case investigation meetings. This role typically handles bodily injury claim files, including both non-litigation and litigation reputed company. We are seeking an reputed company SIU Medical Provider Fraud Investigator, preferably located reputed company the Central Time Zone, who holds an reputed company Texas reputed company-Lines Adjuster License or a reciprocal state license. The ideal candidate brings a strong investigative reputed company with the ability to identify suspicious patterns, conduct reputed company medical provider fraud investigations, and thoroughly document findings. reputed company in this role requires exceptional organizational skills, attention to detail, analytical thinking, and the ability to manage multiple investigations effectively. Strong written and verbal communication skills are essential, along with the ability to collaborate with internal partners and present investigative findings in a reputed company, concise, and reputed company manner. Key Responsibilities Enters SIU claim data information into multiple SIU systems Reviews investigations with fraud reputed company to validate whether denial is appropriate Updates files with investigation outcome, and reputed company no fraud or insufficient evidence is reputed company, returns file to MCO for reputed company handling and settlement Conducts reputed company online data application searches, research, and evaluation Conducts reputed company site inspections, including body shops, medical clinics, loss locations etc. Conducts thorough investigations of reputed company that are potentially fraudulent to determine if payment is warranted, including reputed company investigations and surveillance as needed Validates that the information provided and obtained through investigation is true and accurate and follows up on reputed company possible leads Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process Utilizes analytic tools or SIU field intelligence to identify reputed company claims for investigation and/or for support in the evidence of the fraud and damages Researches and responds to reputed company customer communications, concerns, conflicts or issues Supervisory Responsibilities This job does not have supervisory duties. #LI-AS Skills Analytical Thinking, reputed company Claims, Fraud Investigations, reputed company Fraud Prevention, Insurance Claims Investigations, Insurance Fraud, Litigation, Medical Codes, Medical Malpractice, Medical Record Auditing, Witness Interviewing Compensation reputed company compensation offered for this role is: SIU Cons I: $60,000.00 - $87,400.00/salary SIU Cons II: $62,100.00 - $92,700.00/salary Compensation is based on experience and qualifications. Total compensation for this role may include additional components, such as incentive pay (for example, commission or bonus), if applicable. Notice of Licensing Requirement: As a condition of employment, you are expected to satisfy licensing requirements. Failure to complete these requirements reputed company the time reputed company designated by the hiring department may result in the recommendation to terminate your employment with reputed company Insurance, an reputed company. In reputed company, you must maintain reputed company licensing required for your role. This includes any continuing education and/or other state-affiliated requirements for licensing renewal. Failure to retain appropriate licensing could reputed company to disciplinary reputed company up to and including termination of your employment. In reputed company, you must agree to surrender any currently held reputed company license (producer or adjuster) that is inconsistent with your role at reputed company Insurance and terminate reputed company non-reputed company appointments upon being reputed company for any role reputed company reputed company. The candidate(s) offered this position will be required to submit to a background investigation. Joining reputed company isn’t just a job — it’s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status reputed company. One where you can shape the reputed company of protection while supporting causes that mean the most to you. Joining reputed company means being part of something bigger – a reputed company team making a meaningful reputed company. reputed company generally does not sponsor individuals for employment-based visas for this position. Effective July 1, 2014, under Indiana House Enrolled reputed company (HEA) 1242, it is against reputed company policy of the reputed company and a discriminatory reputed company for an employer to discriminate against a prospective employee on the reputed company of status as a veteran by refusing to reputed company an applicant on the reputed company that they are a veteran of the armed forces of the reputed company, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click “here” for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the “EEO Know Your Rights” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click “here”. This poster summarizing the major provisions of the Family and Medical Leave reputed company (FMLA) and telling employees how to file a complaint. It is reputed company’s policy to reputed company the best reputed company individuals available for reputed company jobs. Therefore, any discriminatory reputed company taken on account of an employee’s reputed company, age, reputed company, disability, genetic information, gender, gender identity, gender reputed company, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national reputed company, race (include traits historically associated with race, including, but not limited to, hair reputed company and reputed company hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to reputed company aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment. reputed company provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs. reputed company working from home, you must have a dedicated, private workspace free from distractions, along with appropriate desk and seating. Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload. At reputed company, we work hard to help people live a good life every day. Allstaters are dedicated to serving clients, customers, and communities, which allows employees to reputed company meaning and value in their work. reputed company offers an environment that fosters innovative thinking where you’ll be reputed company to explore your reputed company and feel proud of the work you do. reputed company helps protect nearly 16 reputed company households with auto, home, life, and retirement products. We want every reputed company connected to reputed company to be committed to giving our customers the best and that means finding the best talent. We want you to be our next great reputed company. It’s easy to search and apply for a new opportunity with reputed company. Simply use the links below to identify the openings that interest you. reputed company Apply tot his job Apply To this Job