Fraud Examiner

🔥 19 hours ago

🦌 Connecticut, New Jersey, +1 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $42.2k - $66k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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• Open for 1 day.
• Jobs at this company usually fill in 21 days.

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Provide support to SIU investigators through preliminary investigative tasks and data analysis • Synthesize, analyze, and process healthcare claims data and financial information in Excel • Create tables and pivot tables for internal review and reporting • Maintain an Agency Referral Log of incoming agency requests for information • Obtain information in response to RFIs for legal department approval • Monitor the Restricted Recipient Program by notifying departments of incoming informational packets • Mail Restricted Recipient Program information to members • Coordinate member and provider packets for members restricted by the Member Review and Restriction Committee • Monitor internal mailboxes for investigative inquiries • Assist investigators with interviews, information review, and determining further investigative steps • Attend Marketing Incidents Committee meetings, manage notes and minutes, and update the Marketing Log with decisions and directives • Assist SIU colleagues with Fraud, Waste and Abuse issues and problem solving • Perform additional duties, including minor administrative tasks supporting the department

🎯 Requirements

• AA/AS degree from an accredited institution • Intermediate Word and Outlook skills • Intermediate/Advanced Excel skills including pivot tables and basic formulas • Data analysis experience • Prior experience in either insurance claims investigation/audit or other professional investigations • Critical thinking, analytical skills and teamwork experience • Good oral and written communication skills, including an ability to summarize data analysis and contribute to investigative reports • Preferred: Bachelor’s Degree from an accredited institution • Preferred: Experience with Tableau and/or SAS • Preferred: Knowledge of Medicare and Medicaid and/or healthcare claims data • Preferred: Knowledge of medical claims processing and investigations and ability to read medical records • Preferred: Knowledge of applicable fraud statutes, regulations, CMS guidelines, and Federal and State insurance reporting requirements • Preferred: Spanish or other language proficiency

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package

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