Why This Role is Important to Us
The Associate Investigator works with a growing team conducting and managing Health Care Fraud, Waste and Abuse investigation and prevention activities under the general direction of the Director or designee. Supervision Exercised : No
What You'll Be Doing
- Plan, organize, and execute investigations or audits utilizing document review, witness interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate action.
- Document and track activity in internal database, provide case updates on progress of investigation, and coordinate with management recommendations and further actions and / or resolutions.
- Prepare detailed reports on investigative findings for internal tracking, review and referral to Federal and State agencies as indicated.
- Utilize data mining and visualization programs to design queries and analyze claims data to detect outliers or suspicious patterns for further investigation.
- Conduct detailed research to identify and apply appropriate regulatory, contractual and industry requirements to the different benefits and products within investigations.
- Proactively seek out and develop leads, resources and opportunities from a variety of sources, and develop and maintain relationships with enterprise, industry, law enforcement and other contacts.
- Complete special projects and audits as required.
- Understand and adhere to HIPAA privacy requirements.
Working Conditions : Standard Office Conditions.
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The Associate Investigator works with a growing team conducting and managing Health Care Fraud, Waste and Abuse investigation and prevention activities under the general direction of the Director or designee. ...
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