Analyst, Special Investigative Unit
Description: • Conducts investigations of known or suspected acts of healthcare fraud, waste, and abuse • Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases • Investigates to prevent payment of fraudulent, abusive, or otherwise improperly billed claims submitted by providers, members, and others • Facilitates the recovery of company and customer monetary losses • Provides input regarding controls for preventing or monitoring fraud related issues within the business units • Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company • Maintains open communication with constituents within and external to the company • Uses available resources and technology in developing evidence, supporting allegations of fraud, waste, and abuse • Researches and prepares cases for clinical and legal review • Documents all appropriate case activity in tracking system • Makes referrals, both internal and external, in the required timeframe • Exhibits behaviors outlined in Employee Competencies • Exhibits behaviors outlined in SIU Investigator Competencies • May include travel to testify in court proceedings or training if necessary Requirements: • 1-3 years of Investigative experience in healthcare fraud, waste and abuse • Strong knowledge of medical terminology/CPT/HCPCS coding • Advanced skills with Microsoft Excel • Experience in healthcare/medical insurance claims investigation or professional/clinical experience • Background with law enforcement agencies involving economic or insurance related matters; or professional investigation experience involving economic or insurance related matters; or an authorized medical professional to evaluate medical related claims • Strong analytical and research skills • Proficient in researching information and identifying information resources • Proficiency in Word, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information • Strong verbal and written communication skills • Strong customer service skills • Ability to interact with different groups of people at different levels and provide assistance on a timely basis • Ability to utilize company systems to obtain relevant electronic documentation • Exhibits behaviors outlined in Employee Competencies • Exhibits behaviors outlined in SIU Investigator Competencies • May include travel to testify in court proceedings or training if necessary Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Benefit solutions addressing the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility Apply tot his job