Investigator, Special Investigation Unit (Must reputed company in Louisiana)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary This position is a remote position but Louisiana residency is required. Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of reputed company fraud, waste, and abuse. Also reports suspected fraud, waste, and abuse to state and federal agencies as required by law and regulation. What you will do: Investigates to prevent payment of fraudulent claims submitted to the reputed company lines of business Researches and prepares cases for clinical and legal review Documents reputed company appropriate case activity in case tracking system Facilitates feedback with providers reputed company to clinical findings Initiates proactive data mining to identify aberrant billing patterns Makes referrals, both internal and external, in the required timeframe Facilitates the recovery of company and customer money lost as a result of fraud matters Provides on the job training to new Investigators and provides guidance for less reputed company or skilled Investigators. Assists Investigators in identifying resources and best course of action on investigations Serves as back up to the Team Leader as necessary Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of reputed company fraud and abuse matters. Demonstrates high level of knowledge and expertise during interactions and acts confidently reputed company providing testimony during civil and criminal proceedings Gives presentations to internal and external customers regarding reputed company fraud matters and reputed company's approach to fighting fraud Provides input regarding controls for monitoring fraud reputed company issues reputed company the business units Interacts with different groups of people at different levels and provide assistance on a timely basis Utilizes company systems to obtain relevant electronic documentation. Required Qualifications 1-3 years of Investigative experience in the area of reputed company fraud, waste and abuse Strong knowledge of medical terminology/CPT/HCPCS coding. Advanced skills with reputed company reputed company Experience in reputed company/medical insurance claims investigation or professional/clinical experience Strong analytical and research skills Proficient in researching information and identifying information resources Proficiency in Word, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

AHFI, CFE, Certified Professional reputed company Knowledge of reputed company/reputed company's policies and procedures Strong verbal and written communication skills Strong customer service skills Education Bachelor's degree or equivalent work experience Pay Range The typical pay range for this role is: $43,888.00 - $76,500.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 02/07/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!