JR111671 Investigator lLocation : This position will work a hybrid model (remote and office). T he ideal candidate will reside WITHIN 50 miles of one of our PulsePoint locations. The associate will work fully virtual and come onsite for trainings, meetings, or as otherwise required by the manager.The Investigator l is responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices.How you will make an impact:Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers.Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.Preparation of final case reports and notification of findings letters to providers.Receive offers of settlement for review and discussion with management.Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings.Minimum Requirements:Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities, and Experiences:Experience with Microsoft office (Excel, Word, PowerPoint) strongly preferred.Excellent verbal/written communication skills strongly preferred.Excellent analytical and problem solving experience preferred.#J-18808-Ljbffr

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