Job Summary
A health insurance company is seeking a Remote Healthcare Fraud Investigator II.
Candidates will be responsible for the following:
- Providing claim reviews for appropriate coding, data mining, and entity review
- Identifying and developing enterprise-wide specific healthcare investigations
- Establishing rapport and on-going working relationship with law enforcement
Skills and Requirements Include:
- BA/BS degree, 3+ years related experience; or equivalent of education and experience
- Knowledge of Plan policies and procedures in all facets of benefit programs management
- Fraud certification from CFE, AHFI, AAPC or coding certificates preferred