Fraud Auditor Associate

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

📋 Description

• Conduct entry-level investigations and audits related to fraud under the direct guidance of a team manager or lead.

• Assist in the investigation of medical service providers, developing cases and reports for law enforcement referrals, educational purposes, overpayment recovery, and administrative actions.

• Collaborate with internal resources, external agencies, state and federal investigators, and other personnel to build cases, audits, and corrective measures.

• Manage multiple caseloads simultaneously; organize and analyze information effectively.

• Contribute to complex reports by applying relevant regulations or rules to affected programs.

• Investigate relevant offenses and carry out efficient audits.

• Identify or confirm suspected violations through observation, record examination, and interviews.

• Review investigation and audit findings to assess whether allegations are substantiated and recommend appropriate corrective actions.

• Draft objective and precise correspondence.

• Ensure the confidentiality of health privacy information and adhere to applicable laws, rules, and regulations.

• Organize case files and document investigative and audit activities thoroughly.

• Create correspondence, reports, and summary letters for referrals.

• Provide education to providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard issues.

• Report work activities promptly.

• Participate in meetings and training conferences; overnight travel may be required.

⛳️ Requirements

• 0 years of experience with a BS/BA or 4 years with a HS Diploma/equivalent.

• Experience in investigative and analytical roles.

• Excellent communication and organizational skills.

• Proficient computer skills.

• U.S. citizenship is required.

• Strong background in investigations or compliance audits is preferred (most competitive candidates).

• Experience in reviewing claims for technical compliance, conducting medical reviews, and/or developing fraud cases and identifying overpayments is preferred (most competitive candidates).

• Knowledge of investigative or auditing practices related to healthcare providers is preferred (most competitive candidates).

• Familiarity with Medicare and/or Medicaid programs, including associated rules, regulations, policies, and procedures is preferred (most competitive candidates).

• Background in evaluating, reviewing, and analyzing medical claims and records is preferred (most competitive candidates).

• Ability to learn and operate data systems, equipment, and tools used in investigations.

• Competency in research and drawing conclusions.

• Capability to interpret laws and regulations.

• Ability to handle confidential materials appropriately.

• Willingness to work under direct supervision as part of a team.

• Availability to attend meetings and training conferences; overnight travel may be required.

🏝️ Benefits

• Telework options available within the Eastern Time Zone.

• Overtime eligibility may apply.

• Shift differentials may be applicable.

• Discretionary bonuses may be offered.

• Commitment to equal opportunity employment, including for individuals with disabilities and protected veterans.