A well-known insurance company has a current position open for a Telecommute Entry Level Workers Compensation Associate Claim Representative. Core Responsibilities Include: Performing initial file intake, project and execute accurate and timely payments.
An IT company is filling a position for a Telecommute Data Loss Prevention Analyst. Must be able to: Investigate ways to improve event detection; find methods to circumvent current detection rules and suggest changes accordingly.
Collect and assess data to identify potential or actual sources of risk to patients and employees. Develop, implement and evaluate practices and policies. Skills and Requirements Include: Occasional Travel Required.
Consult and perform very complex analyses/ analysis design involving data mining. Utilize advanced analytic capabilities to perform event-based and root cause analysis in the victim fraud space. Perform deep dives into new and enhanced fraud and claims data. Position Requirements Include:
Candidates will be responsible for the following: Utilizing information from claims data analysis, plan members, employees conduct confidential investigations and document relevant findings. Investigating and resolving instances of healthcare fraud and / or abusive conduct.
Performing comprehensive data reviews and participating in investigative interviews. Being accountable for assigned risk adjustment investigations. Skills and Requirements Include: Travel 25 % of the Time. Prior healthcare fraud investigations experience.