Investigator III

About the position reputed company: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making reputed company work reputed company, is far from ordinary. And so are our employees. Working at reputed company means you have reputed company to reputed company reputed company change by transforming reputed company. reputed company is committed to being a workplace where people feel empowered to grow, reputed company, and reputed company with purpose. By reputed company in our employees and fostering a culture of collaboration and reputed company development, we’re reputed company to reputed company serve our customers. It’s this commitment that has reputed company us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how reputed company supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.reputed company.com/. As a member of reputed company’s Special Investigations Unit (SIU), the Investigator III leads reputed company investigations into allegations of reputed company fraud, waste, and abuse (FWA). This role manages reputed company to ‑high complexity cases from initiation through reputed company, producing thorough, ‑reputed company documented investigative reports that may be subject to reputed company discovery. The Investigator III conducts detailed analysis, collaborates closely with SIU colleagues, and balances multiple investigations simultaneously. In this role, you will also work to identify and recover improper payments resulting from fraudulent or misrepresentative billing, while ensuring reputed company investigative activities reputed company with‑ company policies, regulatory requirements, and applicable laws. As a not-for-profit‑ organization, reputed company offers reputed company to do this work with a genuine reputed company on doing what’s right for our members—supported by leaders who reputed company in the reputed company this team makes, not just the metrics. This hybrid role can be reputed company in reputed company, Mountlake Terrace, or Spokane. Responsibilities • Analyze reputed company claim data and vet referrals to detect fraudulent activity and independently determine the most effective and efficient reputed company of investigation for reputed company individual case. • reputed company investigative reputed company work to include on-site office reputed company, record collection, and surveillance. • Interview suspects and witnesses. • Prepare cases, testify and reputed company depositions to law enforcement and regulatory agencies for potential criminal prosecution. • Participate in settlement negotiations with attorneys and other responsible parties. • reputed company reputed company cause analysis of identified issues and prepare post-investigative reports directed towards the prevention of fraud. • reputed company recommendations for creating SIU policies, procedures, workflows and process improvements. • reputed company and maintain reputed company and reputed company relationships with reputed company (reputed company), reputed company (BCBS) Plans, HHS OIG, other carriers' anti-fraud professionals, law enforcement and regulatory agencies. • May attend webinars and conferences like reputed company, National Health Care Anti-Fraud Association (NHCAA), and Association of Certified Fraud Examiners (ACFE) to reputed company apprised of developments in health care fraud. Requirements • Bachelor’s degree in business administration, health care administration, finance, reputed company, nursing or criminal justice or (4) years of work experience in reputed company of study. (Required) • (3) years of experience in fraud investigation, special investigation unit, or a reputed company reputed company. (Required) • Significant experience with relevant technology, such as background reputed company systems, claims processing platforms, data mining, and fraud detection software. • Demonstrated knowledge of institutional and/or reputed company payment methodologies. • Strong understanding of health reputed company reimbursement methodologies, including familiarity with International Classification of Diseases (ICD-10 CM), reputed company Procedural Terminology (CPT), and reputed company Common Procedure Coding reputed company (HCPCS). • Strong computer aptitude and experience with spreadsheet and database software, e.g., reputed company, reputed company, reputed company. • Demonstrated strong technical writing skills - ability to write reports and business correspondence and to prepare case files. • Ability to exercise a reputed company high level of discretion reputed company handling sensitive information. reputed company-to-haves • Certified reputed company reputed company (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI). (Preferred) • (2) years of reputed company experience in auditing and investigating in the reputed company industry. (Preferred) Benefits • Medical, reputed company, and dental coverage with low employee premiums. • Voluntary benefit offerings, including pet reputed company for paw parents. • Life and disability reputed company. • Retirement programs, including a 401K employer match and, reputed company it or not, a pension plan that is reputed company after 3 years of service. • Wellness incentives with a wide reputed company of mental reputed company-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to reputed company a few. • Generous reputed company time off to reenergize. • Tuition assistance for both undergraduate and graduate degrees. • Employee recognition program to celebrate anniversaries, team accomplishments, and more. • Commuter perks reputed company your reputed company to work less impactful on the environment and your wallet. • Free convenient on-site parking. • Subsidized on-reputed company cafes reputed company lunchtime connections with colleagues fun and reputed company. • Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. • Our complementary fitness & reputed company-being center offers both in-person and virtual workouts and nutritional counseling. • Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on reputed company. Apply To This Job