Senior Fraud and Waste Investigator

About the position The Senior Fraud and Waste Professional conducts investigations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Professional coordinates investigation with law enforcement authorities. Assemble evidence and documentation to support successful adjudication. Conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepare complex investigative and audit reports. Begin to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and perform work without direction. Exercise considerable latitude in determining goals and approaches to assignments. Use your skills to make an impact.

Responsibilities

• Conducts investigations of allegations of fraudulent and abusive practices.
• Coordinates investigation with law enforcement authorities.
• Assembles evidence and documentation to support successful adjudication.
• Conducts on-site audits of provider records ensuring appropriateness of billing practices.
• Prepares complex investigative and audit reports.

Requirements

• Must be a Florida resident
• Bachelor's degree
• At least 2 years of healthcare fraud investigations and auditing experience
• Knowledge of healthcare payment methodologies
• Strong organizational, interpersonal, and communication skills
• Inquisitive nature with ability to analyze data to metrics
• Computer literate (MS, Word, Excel, Access)
• Strong personal and professional ethics
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice-to-haves

• Graduate degree or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, or AHFI).
• Understanding of healthcare industry, claims processing and investigative process development.
• Experience in a corporate environment and understanding of business operations

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

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