Senior Fraud Investigator Job at TruBlu HR Solutions, Bellaire, TX

Nm52YWlRTllpYWJzeGhDOVRxZk02eEFvMlE9PQ==
  • TruBlu HR Solutions
  • Bellaire, TX

Job Description

Skills/Qualifications

  • HS diploma or GED or Bachelor’s degree
  • 8 years of experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU) including 1 yr experience working with Medicaid
  • Must hold one of the following certifications :
  • CPA (Certified Public Accountant)
  • CFE (Certified Fraud Examiner)
  • AHFI (Accredited Health Care Fraud Investigator)
  • INT – POPC Intermediate Peace Officer Proficiency Certificate

  • Strong analytical and research skills.
  • Proficient in researching information and identifying information resources.
  • Exercises independent judgement and uses available resources and technology in developing evidence and supporting allegations of fraud, waste, and abuse.
  • Knowledge of medical terminology and/or experience with CPT codes, and ICD-9, ICD-10 coding.
  • Knowledge of suspected FWA trends and matters of interest to law enforcement and regulators.
  • Strong communication and customer service skills.

Job Duties

  • Coordinates with subcontractors on overseeing investigations of Fraud, Waste & Abuse (FWA).
  • Manages a large fraud investigation caseload and investigates allegations relating to potential health care fraud perpetrated by Medicaid and commercial providers, vendors, and enrollees.
  • Provides internal and external case updates on progression of investigations in coordination with SIU team members and other departments, including recommendations on further action and/or resolution, as needed.
  • Continually interfaces with members, vendors, pharmacies, providers and other third parties via telephone, e-mail, and on-site visits as needed to identify, further, and conclude ongoing investigations.
  • Implements processes and procedures to: prevent, detect, investigate and report FWA to appropriate regulatory agencies.
  • Provides inter-departmental input regarding controls for preventing and monitoring FWA issues.
  • Proactively identifies trends and aberrant activity to generate leads for FWA investigations.
  • Performs special assignments related to FWA as assigned by the Director of Controls and Compliance.

Job Tags

For subcontractor,

Similar Jobs

Motion Recruitment

CAD Designer Job at Motion Recruitment

 ...Description: We are seeking an Engineering Designer I to assist the Engineering team. The Engineering team maintains the safety and longevity of our towers and ensures high level compliance with industry standards. Day to day you will use Computer Aided Drafting and... 

FusionSite

Marketing Internship (Graphic Design & Content Creation) Job at FusionSite

 ...Role Overview The Marketing Intern will gain hands-on experience in digital marketing, branding, and content creation while leveraging your graphic design and videography skills to support our marketing initiatives. This role is ideal for someone creative, detail... 

Fuse Fundraising

Creative Operations Coordinator Job at Fuse Fundraising

 ...The Creative Operations Coordinator serves as primary point of contact for the coordination, review and output of all creative and content for assigned accounts. Individuals within this role will serve as the primary liaison between the direct mail and digital Strategy... 

Servi-Tek Facility Solutions

Night Operational Specialist (Part-Time) Job at Servi-Tek Facility Solutions

 ...operations meet the highest standards by training and supervising night staff, overseeing compliance with safety protocols, and ensuring...  ...or equivalent (required); College degree (preferred)~ Valid Drivers License and proof of insurance (required) Skills & Competencies... 

Froedtert South, Inc.

Surgical Technologist Certified Job at Froedtert South, Inc.

 ...procedures, and implementation tools and technologies to facilitate a physician's performance of invasive therapeutic procedures. ~...  ...in The National Board of Surgical Technology and Surgical Assisting (NBSTSA). ~Employees hired into position as of January 1,...