Senior Investigator
Highmark Health·Remote(United States)
Other
Excel
WFA Digital Insight
As demand for anti-fraud specialists grows, roles like this Senior Investigator position are becoming increasingly important in the US healthcare sector. With a focus on Excel skills and experience in clinical nursing or medical coding, candidates can leverage their expertise to drive fraud prevention. Highmark Health's commitment to proactive measures makes this an attractive opportunity for professionals looking to make an impact.
Job Description
About the Role
The Senior Investigator will develop and maintain an anti-fraud program, including training and filing of Fraud Plans and Reports.Responsibilities
- Conduct investigations into potential and existing provider and member fraud, waste, and abuse activities.
- Identify parties involved by reviewing inquiries and complaints.
- Conduct interviews with providers, members, or other individuals necessary for an investigation.
- Determine the scope of allegations by assembling necessary information, statistics, and policies.
Requirements
- Clinical Nursing and/or Medical Coding experience is required.
- Proficiency in Excel is necessary.
Nice to Have
- Experience with audits for proactive and investigative purposes.
How to Stand Out
- Ensure your resume highlights specific examples of fraud investigation and Excel expertise.
- Prepare to discuss your approach to maintaining confidentiality during investigations.
- Showcase any experience with data analysis and interpretation of large datasets.
- Be ready to explain how your clinical or medical coding background informs your investigative work.
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