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

Y1BNNzVBWEVGMWl0NWNpYWNoZXUrdkxZS3c9PQ==
  • 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

Arcetyp LLC

Radiologist in Japan Job at Arcetyp LLC

 ...accept corp-to-corp (C2C) candidates. We can't sponsor H1B.Arcetyp LLC is looking for a Radiologist to support the Government in Japan. This will be an on-site, in-office position located at the Naval Hospital Okinawa, in Okinawa Japan.There are relocation expenses... 

Inter-Continental Cigar Corporation

Sales Area Manager Job at Inter-Continental Cigar Corporation

 ...a loyal consumer base and distribution across major regional markets in specialty and mass market retail channels. The Sales Area Manager is responsible for the further development and extension of sales in his/her area according to the company strategy of adherence... 

F.A. International Logistics

Fully-Remote Freight Agent Job at F.A. International Logistics

FA International is looking for Freight Agents who enjoy working remotely. Here at FA, we are striving to offer everyone a different lifestyle...  ...prospects and customers by providing them with a world class experience - Identify customer needs to determine how our solutions... 

Hillstone Restaurant Group

SUMMER INTERNSHIPS Job at Hillstone Restaurant Group

 ...Hillstone offers a limited number of summer internships to exceptional candidates currently enrolled in an accredited undergraduate institution. The three-month paid program is essentially a miniature version of our management training program, in which the intern will... 

RedefineU

Cameraman - Part-Time Job at RedefineU

 ...is for a part time/full time videographer located in Charlotte, NC. The Videographer will be responsible for video production, camera operation, lighting, shooting video, and camera work on a day-to-day basis as well as editing. Qualifications Video Production...