Job Summary
A healthcare provider has a current position open for a Telecommute Healthcare Insurance Investigator in Columbia.
Core Responsibilities of this position include:
- Prioritizing, triaging and managing workload to meet internal performance metrics, regulatory and contractual requirements
- Analyzing data and selecting audit samples using various sampling methodologies
- Planning and conducting desk audits, field audits and/or site visits
Qualifications for this position include:
- Site visits
- A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)
- Knowledge of managed health care business model and processes, preferably in behavioral health, radiology or pharmacy
- Minimum of five years of experience in fraud investigations, claims processing, auditing or provider networks
- Demonstrated abilities in time management and establishing priorities
- All other requirements necessary for this position
