Job Summary
A healthcare company needs applicants for an opening for a Telecommute Senior Investigator in Eden Prairie.
Core Responsibilities Include:
- Conducting confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations
- Reviewing claims, looking for patterns of potential fraud, waste and / or abuse and interacting with medical providers to request medical records for investigations
- Conducting onsite provider claim and / or clinical audits
Must meet the following requirements for consideration:
- High school diploma
- 3 years of experience working in a government, legal, law enforcement, investigations, healthcare, managed care and / or health insurance environment
- 3 years of experience in a position processing medical claims and / or investigating fraud
- Experience communicating complex information via phone conversations and emails to non - technical clients
