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SIU/Fraud Investigator- Long Term Care

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

Minnesota (USA), United States

Offer summary

Qualifications:

Experience in investigations or fraud detection, Knowledge of state and federal laws, Strong analytical and documentation skills.

Key responsabilities:

Conduct investigations on potential fraud cases
Prepare responses for suspected fraud
Collaborate with cross-functional teams
Ensure compliance with legal requirements
Schedule surveillance as required

illumifin Insurance Large https://illumifin.com/

1001 - 5000 Employees

See more illumifin offers

Job description

The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative.

WE ARE THE KIND OF EMPLOYER YOU DESERVE.

A SIU/Fraud Investigator is responsible for working with multiple business units on coordination, identification, mitigation, and reporting of incidents and risks related to anti-fraud activities.

Conducts and assists with investigative tasks
Reviews referrals of potential fraud, waste, and abuse from both auto-detection programs and from claims organization, as assigned
Coordinates and performs investigations with oversight of lead investigator
Prepares responses for suspected or alleged fraud
Works closely with cross-functional leaders to ensure appropriate resolution, accurate reporting and tracking to meet client specific service level agreements
Participates as a subject matter expert during client implementations, audits and system or process development
Complies with state and federal laws to meet client contractual requirements
Conducts effective research, analysis, and accurate documentation for reporting to clients and illumifin’s leadership
Schedules surveillance once approved by the client
Conducts continuing education to Claims staff
May conduct phone calls or basic interviews with witnesses, as assigned
Assists with administration tasks relating to Fraud Services Department, as assigned
Assists with client and department reporting
Interfaces with claimants, providers and clients
Conducts telephonic interviews of members, providers, and/or additional witnesses to gather information to support investigation
Other duties as assigned