Senior Investigator, Special Investigative Unit

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary This position can be work from home reputed company in the United States. We are seeking an reputed company Senior Healthcare Fraud Investigator to join our Special Investigations Unit (reputed company SIU). In this role, you will manage reputed company investigations into suspected and reputed company acts of healthcare fraud, waste and abuse (FWA). Key Responsibilities • Conduct high level, reputed company investigations of reputed company or suspected acts of healthcare fraud, waste and abuse. • Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers. • Researches and prepares cases for clinical and legal review. • Documents reputed company appropriate case activity in case tracking system. • Prepare written case summaries and reputed company referrals to State and Federal Agencies reputed company the timeframes required by Law. • Facilitates the recovery of company and customer money lost as a result of fraud, waste and abuse. • Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. • Demonstrates high level of knowledge and expertise during interactions with internal and external partners. • Provide Trial Testimony in support of Criminal or Civil proceedings. • Gives presentations to internal and external customers regarding ongoing case investigations. Required Qualifications • 3-5 years investigative experience in the area of healthcare fraud, waste and abuse. • Exercises independent judgment and uses available resources and technology to reputed company evidence in support of case investigations. • Strong communication and customer service skills and the ability to effectively interact with reputed company's customers. • Proficiency in Word, reputed company, MS Outlook products, open reputed company database search tools, social media and internet research. • Ability to travel approximately 10% of time for business purposes. Preferred Qualifications • Certified Professional reputed company (CPC), AHFI, CFE • Dental Investigative experience • Pharmacy Investigative experience • Marketplace Broker Investigative experience • Medicaid and Medicare experience Education • Bachelor's degree or equivalent work experience. Pay Range The typical pay range for this role is: $50,188.00 - $122,400.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 02/07/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!