Investigator II

Responsibilities Identification, investigation and development of cases against perpetrators of healthcare fraud Claim reviews for appropriate coding, data mining, entity review and law enforcement referral Identification and development of enterprise‑wide healthcare investigations Establishment of rapport and ongoing working relationships with law enforcement Assistance in training of internal and external entities Requirements BA/BS degree and a minimum of 3 years related experience Fraud certification from CFE, AHFI, AAPC or coding certificates preferred Knowledge of plan policies and procedures across all facets of benefit program management with heavy emphasis on negotiation preferred Health insurance and law enforcement experience preferred Core Competencies Demonstrates expertise in healthcare fraud investigation, including case development and coding review, while effectively collaborating with law enforcement and training stakeholders. Possesses strong knowledge of benefit program management and negotiation within the health insurance domain. #J-18808-Ljbffr Jobtailor