Florida Licensed FWA Claims Specialist
Job Summary
Investigating and analyzing potential Fraud, Waste, and Abuse (FWA) cases, the full-time Florida Licensed FWA Claims Specialist will ensure compliance with regulations, recommend corrective actions, and collaborate with stakeholders while working remotely.
Key responsibilities
- Conduct thorough investigations of suspected FWA cases and analyze data to identify patterns
- Ensure adherence to relevant FWA laws, regulations, and policies
- Prepare reports and documentation on FWA investigations, findings, and recommendations
Required qualifications
- High School/GED required; college degree, certified billing/coding, and/or nursing degree preferred
- 5-8 years of experience in FWA analyses and/or medical and coding/FWA reviews
- Claims processing experience
- Knowledge of medical claims and coding
- Understanding of benefit, contract, and pricing interpretation
Complete Job Description
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