Fraud and Waste Investigator

This is a fully remote position, open to applicants in United States.

📋 Description

• Carry out investigations into claims of fraudulent and abusive behaviors.

• Collaborate with law enforcement agencies during investigations.

• Gather evidence and documentation to facilitate successful adjudication.

• Perform on-site audits of provider records to verify correct billing practices.

• Draft intricate investigative and audit reports.

• Analyze guidelines and autonomously decide on suitable actions.

• Make decisions about work methods in unclear situations with limited guidance.

• Adhere to established guidelines and procedures.

⛳️ Requirements

• A bachelor's degree is required.

• Two years of experience in healthcare fraud investigations and auditing.

• Understanding of healthcare payment methodologies, claims, submissions, and payments.

• Excellent organizational, interpersonal, and communication abilities.

• A curious mindset with the capability to analyze data against metrics.

• Proficient in MS Word, Excel, and Access.

• Strong personal and professional ethics.

• A commitment to enhancing consumer experiences.

• Capability to provide a high-speed DSL or cable modem for a home office setup.

• Minimum internet speed of 25 Mbps download and 10 Mbps upload is required.

• Satellite and wireless internet services are not permitted.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Availability to work Monday through Friday, 8 hours per day, for 5 days a week.

• Must be able to work in EST/CST time zones.

🏝️ Benefits

• Benefits commence on the first day of employment.

• Competitive 401k matching available.

• Generous accrual of Paid Time Off.

• Tuition reimbursement offered.

• Parent leave provided.

• Go365 perks to promote well-being.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan available.

• Paid time off, including company holidays and personal holidays.

• Paid parental and caregiver leave included.

• Short-term and long-term disability coverage.

• Life insurance offered.

• Bonus incentive plan available.

• Employer reimbursement for internet expenses for associates or contractors working from home in California.