Position Summary
Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products for assigned Plan.
Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.
This position is fully remote.
Equal Opportunity Employer of Minorities / Females / Disabled / Veterans
LI-AK1
Qualifications : Required :
Required :
- Associate Degree in business, health care or related field.
- Three (3) years’ experience in progressively more responsible positions using analytical skills with at least two (2) years’ experience in compliance or related function.
Preferred :
- Bachelor’s Degree in business, health care or related field.
- Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC.
- Two (2) years’ experience and knowledge of HMO, or PPO (e.g. accounting / finance, reinsurance, regulatory compliance, claims processing, membership / eligibility, and actuarial precepts).
- Course work or work experience in statistics.
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