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Job Summary
This Position Is Responsible For Planning And Developing Investigation Tools And Techniques To Conduct Detailed Investigations Of Potentially Fraudulent This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery and litigation.
Also, reviews operational controls, and claim system controls and protocols, and recommends enhancements to reduce the potential for fraud.
JOB REQUIREMENTS :
- Bachelor’s Degree
- 5 years law enforcement experience (local, state, or federal) OR 3 years health care fraud investigative experience.
- Familiarity with laws applicable to health care fraud.
- Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
- Ability to independently prepare reports of interview and other documentation accurately reflecting investigative activity and results.
- Clear and concise verbal and written communication skills.
PREFERRED REQUIREMENTS :
- Accredited Health Care Fraud Investigator
- Certified Professional Coder
- Certified Fraud Examiner
- Knowledge of health care claims processing and benefit administration.
Please note that this role is HYBRID with an in office requirement of 3 days a week
LI-LK1
LI-Hybrid
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HCSC Employment Statement :
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
$53,500.00 - $118,100.00
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