What are the responsibilities and job description for the Lead Fraud Investigator position at Health Care Service Corporation?
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
BASIC FUNCTION HCSC is looking for a dynamic individual to join its Fraud Investigations team! This position will be responsible for identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and the misuse of claims, billing, or improper payments. May also be responsible for establishing and maintaining close liaison (as indicated in plan design) with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Will be reviewing transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testifying in court. Incumbent conducts complex, large-scale investigations and mentor junior-level investigators. expertise in data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills NOTE: this role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days. Relocation is NOT offered; sponsorship will NOT be extended either now or in the future.
Job Requirements
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
BASIC FUNCTION HCSC is looking for a dynamic individual to join its Fraud Investigations team! This position will be responsible for identifying, developing and managing complex, high-impact healthcare fraud investigations resulting in criminal and/or civil prosecution and the misuse of claims, billing, or improper payments. May also be responsible for establishing and maintaining close liaison (as indicated in plan design) with departments/personnel and law enforcement representatives to further the department’s investigation efforts and referral for prosecution of healthcare fraud cases. Will be reviewing transactions, claims, or reports to detect fraud and prepare detailed reports for management, attorneys, or law enforcement and possibly testifying in court. Incumbent conducts complex, large-scale investigations and mentor junior-level investigators. expertise in data analysis tools (e.g., advanced Excel), investigative proficiency, and strong communication skills NOTE: this role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days. Relocation is NOT offered; sponsorship will NOT be extended either now or in the future.
Job Requirements
- Bachelor’s Degree.
- Seven (7) years’ fraud investigative experience OR 7 years of direct law enforcement experience (local, state, or federal).
- Experience directing complex fraud investigations which result in criminal or civil prosecutions.
- Aptitude with planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations.
- Familiarity with state and federal laws apps.
- Expertise in data analysis tools, investigative proficiency, and strong communication skills.
- Proficiency with MS Office (Word, Excel, PowerPoint) as well as Workday.
- Certified Professional Coder (CPC).
- Certified Fraud Examiner (CFE).
- Accredited Health Care Fraud Investigator.
- Exceptional ability to identify fraud, waste and abuse trends and work with advanced analytics in identifying emerging schemes and trends.
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
Salary : $61,500 - $136,100