Fraud Investigator – Healthcare (SGS)
The investigator will be in a position of trust, a role that requires integrity, confidentiality, intensity, commitment and pride in our country’s security matters. The main responsibility of the Investigator is to collect the requested information relevant to fraud investigations pertinent to the contract assignment. The ultimate goal is customer satisfaction achieved through timeliness, meeting or exceeding customer and internal standards, and effective in identifying relevant issues.
o Perform in depth analysis and investigation of potential fraudulent healthcare claims and prepare supporting documentation for administrative actions.
o Timely documentation of all actions
o Utilize data analysis techniques to detect inconsistencies in Medicare claims and develop leads from multiple sources
o Perform investigative practices (conduct interviews, compile documentation and evidence, maintain extensive notes, develop initial and ongoing investigative reports)
o Recommend potential fraud determinations and administrative actions based on source leads
o Participate in on site visits and audits as assigned
o Review and respond to requests from Medicare stakeholders
o Perform other duties as assigned by management in support of ZPIC goals and objectives
o Ability to work without supervision
o Valid drivers license
o Ability to sit for long periods of time
o Proven experience in the Investigator role or 3-5 years of work experience with relevant investigation and/or Medicare experience
o Must possess strong computer skills including Microsoft Office Suite, e-mail and internet
o Ability to handle sensitive and confidential material
o Ability to perform research and draw conclusions
o Ability to interpret laws and regulations
o Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
o Ability to educate providers, provider associations, law enforcement, and other groups
o Ability to exercise independent judgment
o Ability to work independently and as a member of a team
o Ability to multi-task and prioritize work
o Ability to organize a case file, accurately and thoroughly document all steps taken
o Ability to report work activity in a timely manner
· Bachelor degree or 2 years experience in analyst/fraud investigator position.
· Prior investigative experience preferred.
· Strong investigative an analytical skills are required.
· Medicare or Healthcare experience is preferred.
· Strong communication an organization skills.
· Strong PC knowledge and skills of Microsoft Suite applications (Excel, Access, Word, Outlook).
· Must submit to an pass a background and drug test.
Candidates must reside within 50 miles of Hingham, MA at time of hire.
USIS values diversity in its workforce and is an Affirmative Action, Equal Opportunity Employer
USIS ISD - 17 months ago