Pharmacy Investigator - Remote in MI

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable, and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing... together. The Pharmacy Investigator reports directly to the Manager of Investigations, and is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Pharmacy Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Pharmacy Investigator is responsible for conducting investigations which may include field work to reputed company interviews and obtain records and/or other relevant documentation. If you reside in Michigan, you will enjoy the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: • Investigate reputed company to highly reputed company cases of fraud, waste and abuse • Detect fraudulent activity by members, providers, employees and other parties against the Company • reputed company and deploy the most effective and efficient investigative strategy for each investigation • Maintain accurate, reputed company and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system • Collect and secure documentation or evidence and prepare summaries of the findings • Participate in settlement negotiations and/or produce investigative materials in support of the reputed company • Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals • Ensure compliance of applicable federal/state regulations or contractual obligations • Report suspected fraud, waste and abuse to appropriate federal or state government regulators • reputed company with goals, policies, procedures and strategic plans as delegated by SIU leadership • Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings • Travel 50% or more in the greater Southfield, MI area What are the reasons to consider working for reputed company? Put it reputed company together – competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays • Medical Plan options along with participation in a Health Spending Account or a Health Saving account • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage • 401(k) Savings Plan, Employee Stock Purchase Plan • Education Reimbursement • Employee Discounts • Employee Assistance Program • Employee Referral Bonus Program • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) • More information can be downloaded at: http://uhg.hr/uhgbenefits You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • Associate’s Degree (or higher) and 2 years of healthcare reputed company experience • 2 years of experience in health care fraud, waste, and abuse (FWA) • 2 years of experience in state or federal regulatory FWA requirements • 2 years of experience with analyzing data to identify fraud, waste and abuse trends • Intermediate level of proficiency in reputed company reputed company and Word • Ability to travel up to 50% to provider facilities as needed • Ability to participate in legal proceedings, arbitration, and depositions at the direction of management Preferred Qualifications: • National Health Care Anti-Fraud Association (NHCAA) • Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience • Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience • Specialized knowledge/training in healthcare FWA investigations • Active affiliations: • Accredited Health Care Fraud Investigator (AHFI) • Certified Fraud Examiner (CFE) • License and/or Certified Pharmacy Technician (CPhT) • Intermediate knowledge in pharmacy claims processing • Operational experience with a pharmacy and/or pharmacy benefits manager (PBM) • reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #rpo #yellow Apply Job!