Fraud Referral Specialist – Medicare

This is a fully remote position, open to applicants in Alabama, +7 more locations.

📋 Description

• Utilize various tools to assess referrals and complaints, and conduct investigations to detect possible fraud.

• Address referrals from other organizations.

• Handle requests for data and provide support.

• Evaluate and interpret claims data for irregularities.

• Conduct interviews as necessary.

• Document findings and implement swift, appropriate follow-up actions.

• Forward cases to field investigative teams or the data team for additional analysis.

• Engage in research and derive conclusions.

• Highlight issues of concern, referencing regulatory violations and alleging fraudulent schemes against the Government.

• Organize case files and meticulously document all actions taken.

• Perform background investigations on providers within the Medicare program.

• Draft correspondence, reports, and summary referral letters.

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

⛳️ Requirements

• No experience required with a BS/BA; 4 years of experience needed with a high school diploma or equivalent.

• Strong interpersonal, analytical, research, and organizational abilities.

• Exceptional verbal and written communication skills.

• Proficient PC knowledge and skills.

• Advanced Excel skills, including sorting and filtering data.

• Excellent time management and organizational capabilities.

• Self-motivated and driven individual.

• U.S. citizenship is mandatory.

• 1 to 2 years of investigative or analytical experience is preferred.

• May be required to appear in court to provide testimony regarding work findings.

• Ability to communicate effectively both internally and externally.

• Capability to interpret laws and regulations.

• Competence in handling confidential information.

• Ability to report work activities promptly.

• Capacity to work independently as well as part of a team.

• Willingness to attend meetings, training, and conferences.

• Some overnight travel may be necessary.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Health savings account.

• Short-term disability.

• Long-term disability.

• Employee assistance program (EAP).

• Parental leave.

• 401(k).

• Paid time off (PTO) for vacation.

• Company-paid holidays.

• Potential eligibility for overtime.

• Potential eligibility for shift differential.

• Potential eligibility for a discretionary bonus.