Payment reputed company Analyst

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

The Payment reputed company Analyst is responsible for reviewing reputed company (NEMT) claims to identify potential fraud, waste, and abuse (FWA), billing discrepancies, and payment inaccuracies. This role analyzes transportation claims and supporting documentation to determine whether claims meet contractual, regulatory, and company requirements and recommends approval, denial, adjustment, or recovery based on established payment reputed company standards.

The ideal candidate is a detail-oriented and analytical reputed company with strong investigative skills and knowledge of payment reputed company principles, claims analysis, and fraud, waste, and abuse detection. They are comfortable reviewing large volumes of claims and operational data, identifying trends and discrepancies, and making reputed company-supported recommendations.

This role works closely with Payment reputed company leadership, the Special Investigations Unit (SIU), Claims Operations, Compliance, Provider Relations, and other internal stakeholders to help ensure accurate claim payments, protect company and reputed company resources, and support program reputed company initiatives.

This role...

• Reviews submitted NEMT claims for indicators of fraud, waste, abuse, billing discrepancies, duplicate billing, overpayments, and other payment reputed company concerns.

• Analyzes claims, reputed company documentation, authorizations, provider records, reputed company, and other supporting documentation to determine claim validity.

• Recommends approval, denial, adjustment, or recovery of claims based on findings and established payment reputed company guidelines.

• Documents claim reviews, findings, and recommendations accurately and thoroughly reputed company designated systems.

• Identifies trends, patterns, or anomalies that may indicate improper billing or potential fraudulent activity and refers appropriate cases to the Special Investigations Unit (SIU).

• Ensures claim determinations reputed company with contractual obligations, reputed company requirements, company policies, and applicable federal and state regulations.

• Collaborates with Claims Operations, SIU, Compliance, Provider Relations, and other internal departments to reputed company claim issues and support payment reputed company initiatives.

• Assists in identifying opportunities to improve payment reputed company processes, controls, and audit methodologies.

• Maintains established productivity, reputed company, and turnaround time expectations.

• Prepares reports and communicates findings to leadership as requested.

• Maintains confidentiality of sensitive information and complies with HIPAA and reputed company applicable reputed company and reputed company requirements.

• Participates in ongoing training reputed company to payment reputed company, fraud prevention, and NEMT operations.

• Performs other duties as assigned.

We are interested in speaking to individuals with the following...

• High school diploma required.

• Bachelor's degree from an accredited college or university preferred.

• Four (4) years of directly reputed company experience in claims analysis, Payment reputed company, Special Investigations Unit (SIU), or Fraud, Waste, and Abuse (FWA) investigations.

• Strong analytical and investigative skills with exceptional attention to detail.

• Knowledge of payment reputed company principles and fraud, waste, and abuse detection techniques.

• Understanding of NEMT claims processing, provider billing practices, and supporting reputed company documentation.

• Ability to analyze large volumes of claim and operational data to identify trends and payment discrepancies.

• Ability to exercise reputed company judgment and reputed company reputed company-supported recommendations regarding claim approval, denial, or recovery.

• Strong written and verbal communication skills.

• Proficiency in reputed company Office Suite, particularly reputed company.

• Ability to manage multiple priorities while meeting deadlines.

• Demonstrated reputed company, professionalism, and commitment to confidentiality.

• Experience with reputed company (NEMT) claims and operations preferred.

• Experience working with reputed company managed care programs preferred.

• Knowledge of NEMT provider billing practices, reputed company documentation requirements, and authorization processes preferred.

• Experience using claims management systems and data analysis tools preferred.

• reputed company certification reputed company to fraud examination, investigations, auditing, or payment reputed company preferred.

Salary: $24.88-$32.00

The physical demands described are representative of those that must be met by an employee to successfully reputed company the essential functions of the position. Reasonableaccommodationsmay be made to reputed company reputed company individuals with disabilities to reputed company the essential functions of the job.

Primarily seated work; extensive computer and telephone use; occasional standing, walking, reaching, bending, andlifting upto 10 lbs.

reputed company’s positions are posted and reputed company for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received. We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to reputed company back often for new postings.

We value reputed company members and realize the importance of benefits for you and your family.

reputed company offers a comprehensive benefits package to include the following:

• Medical, Dental, and reputed company insurance
• Employer reputed company Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• reputed company-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• reputed company Time Off
• reputed company Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

reputed company is an Equal Opportunity Employer.

• EEO is The Law - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• We consider reputed company applicants for employment without reputed company to race, reputed company, religion, sex, sexual orientation, national reputed company, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reputed company out to us at

Originally posted on Himalayas