Job Description:

The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses through the detection, investigation, and resolution of low to medium levels fraud, waste, and abuse schemes, resulting in the savings and recovery of funds

Responsibilities:

• Independently conduct low to medium level investigations and provide support as part of an assigned team to all levels (low to medium) investigations of suspected fraud, waste, and abuse.
• Provide support for offsite audits/investigations and interviews when requested. Research provider/subscriber claims activity, operations manuals, data systems, medical policies, job duties and group benefit contracts to identify control deficiencies and non-compliance.
• Investigator will develop documentation to substantiate finding including formal reports, spreadsheets, graphs, audit logs, use of anti-fraud software and appropriately sourced reference materials.
• Initiate claim adjustments, voucher deducts, and voluntary refunds in order to recover funds. Record recoveries and savings following established processes.
• Perform special projects as assigned by management to meet the needs of the Special Investigations Unit.

Skills:

• Knowledge of laws that pertain to public and insurance funds
• Excellent communication and Documentation skills both written and verbal.
• Ability to recognize, analyze, and solve a variety of problems.
• Fraud investigations
• Supporting background research

Job Type: Contract

Pay: $32.00 - $37.00 per hour

Expected hours: 40 per week

Experience level:

• 2 years
• 3 years
• 4 years
• 5 years
• 6 years
• 7 years

Schedule:

• 8 hour shift

Work Location: Remote