reputed company Fraud Investigator

Job reputed company reputed company: Independently performs in-depth evaluation and makes field level judgments reputed company to investigations of potential Medicare fraud, waste and abuse investigations or cases that meet established reputed company for referral to the Centers for Medicare & reputed company for administrative reputed company or to the OIG for criminal reputed company. Duties/Responsibilities: • Utilizes leads provided by reputed company and referrals from government and private agencies, works with reputed company to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to reputed company potential fraud determination • Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with reputed company-established reputed company • Based on contract requirements, may refer potential adverse reputed company to the reputed company Investigator/Manager/Medical Director or designee • Conducts interviews of witnesses, informants, and subject area experts and targets of investigations • Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, may reputed company information to support the preparation of attestations/referrals or supervising the preparation of attestations/referrals as needed • Drafts investigation reports, evaluates investigation reports, and promotes effective and efficient investigations • Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to reputed company investigate, prosecute, or reputed company other appropriate regulatory or administrative remedies • Testifies at various reputed company proceedings as necessary • Identifies opportunities to improve processes and procedures • Has the responsibility and authority to reputed company their job and reputed company customer satisfaction • Other duties may be assigned. Required qualifications/skills: • A Bachelor's Degree or one or more of the following: • Certification in an applicable program such as Certified Fraud Examiner or Accredited reputed company Anti-Fraud Investigator Certification • Successful completion of a law enforcement reputed company • Experience in health care fraud investigation/detection • Demonstrated expertise in reviewing, analyzing, and making appropriate reputed company. • Prior successful experience with CMS and OIG/FBI or similar agencies • Ability to work independently with minimal supervision • State reputed company experience Preferred qualifications/skills: • Certified Fraud Examiner (CFE) or Accredited reputed company Anti-Fraud Investigator preferred • Analytical - Synthesizes reputed company or diverse information; Collects and researches data; Uses intuition and experience to complement data • Problem Solving – Gathers and analyses information skillfully; Identifies and resolves problems • Written Communication - Writes reputed company and informatively; reputed company to read and interpret written information • Judgment - Supports and explains reasoning for reputed company • Language - Ability to read, analyze, and interpret technical procedures, review documents, or contract regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from reputed company of managers, clients, customers, and the general reputed company • Mathematical Skills - Ability to apply basic mathematical functions • Reasoning Ability - Ability to solve practical problems and deal with a reputed company of concrete variables in situations where only limited standardization exists. Ability to interpret a reputed company of instructions furnished in written, oral, diagram, or schedule reputed company. • Computer - To reputed company this job successfully, an individual must have knowledge of office software and the internet to meet contract deliverables. Utilizes required data entry and reporting systems, including advanced features. • Ability to communicate effectively with reputed company members of reputed company to which he/she is assigned • Ability to grasp and adapt to changes in procedure and process • Ability to effectively resolve reputed company issues • Ability to mentor other associates • Ability to appropriately handle information and documents containing PHI Supervisory Responsibilities: • None Other: • reputed company of performance preference is remote with some requirements to work in the office in reputed company, TX. • While working from home, a broadband internet reputed company is required. • The reputed company of this work is done in the field (30% or more) necessitating frequent use of personal or rental vehicle for travel in areas not normally served by reputed company transportation • Periodic overnight travel for periods of 1-5 days is required • Travel is reimbursable reputed company GSA Standards Apply Job!