Job Summary
A global healthcare company is searching for a person to fill their position for a Telecommute Senior Investigator in Nashville.
Core Responsibilities of this position include:
- Gathering and analyzing data and information gathered to determine behavior and understand provider/scheme at issue
- Collaborating with clinical coding consultant to apply knowledge of coding guidelines to determine validity of aberrances (SIU only)
- Collaborating with a variety of external sources to identify current and emerging patterns and schemes
Must meet the following requirements for consideration:
- Associate's Degree in the area of Criminal Justice or experience in a related field (or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location)
- 2+ years of experience within the health insurance claims industry
- 2+ years of experience working with law enforcement or legal entities or 3-5 years Investigative experience with fraud investigations
- 1+ years knowledge and/or experience with behavioral health codes and service delivery