Job Description:
• Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols.
• Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure.
• Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions.
• Adheres to industry regulations and company policies for managerial follow-up.
• Analyzes data in order to effectively assess the validity of claims.
• Provides accurate recommendations to management for claim resolution and closure.
• Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes.
Requirements:
• Minimum Bachelor's Degree required
• 0 - 2 years of experience required; 2 - 4 years preferred
• Medicaid experience preferred
• Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator preferred
Benefits: