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Fraud Detection_Fraud Executive Advisor
extra holidays - extra parental leave
Offer summary
Qualifications:
Must be a US Citizen or Permanent Resident., 20+ years of experience in Fraud, Waste, and Abuse (FWA) detection., Experience with the Fraud and Abuse Management System (FAMS) and TriWest T5 Fraud Detection Services Contract., Strong relationships with TriWest C-Suite leadership and experience in healthcare fraud detection..Key responsabilities:
- Support the deployment of the FAMS tool for fraud detection on medical claims.
- Integrate the FAMS tool with the ATOM platform for case management solutions.
- Assist fraud analysts in dispositioning alerts and conducting investigations on flagged claims.
- Collaborate with the FAMS Team to enhance fraud detection capabilities.
51 - 200
Employees
Job description
This is a remote position and a part-time position (15 hours per month)
Must be a US Citizen or Permanent Resident.
Statement of Work:
The client is delivering a NexGen Program Integrity Solution where we will be using the client tool, FAMS (Fraud and Abuse Management System), to perform fraud detection on Defense Health Agency (DHA) active duty medical claims for both pre-payment, known as in-line fraud detection, and post-payment, known as retrospective fraud detection. We will also be integrating this fraud detection tool with the ATOM platform, to provide a case management solution that enables fraud analysists to disposition alerts and conduct investigations on flagged claims as required.
Task Description:
The TriWest Fraud Detection services Fraud Executive Advisor will support the Fraud and Abuse Management System (FAMS) Team as they deploy FAMS to detection fraud on claims within the T5 contract.
Required skills/Level of Experience :
Must be a US Citizen or Permanent Resident.
Statement of Work:
The client is delivering a NexGen Program Integrity Solution where we will be using the client tool, FAMS (Fraud and Abuse Management System), to perform fraud detection on Defense Health Agency (DHA) active duty medical claims for both pre-payment, known as in-line fraud detection, and post-payment, known as retrospective fraud detection. We will also be integrating this fraud detection tool with the ATOM platform, to provide a case management solution that enables fraud analysists to disposition alerts and conduct investigations on flagged claims as required.
Task Description:
The TriWest Fraud Detection services Fraud Executive Advisor will support the Fraud and Abuse Management System (FAMS) Team as they deploy FAMS to detection fraud on claims within the T5 contract.
Required skills/Level of Experience :
- Experience leading Fraud and Abuse Management System (FAMS) Tool implementations
- Experience working on the TriWest T5 Fraud Detection Services Contract
- Experience and relationships with TriWest C-Suite leadership
- Experience with Defense Health Agency fraud detection and VA Community Care Network (CCN) fraud detection
- Experience with healthcare fraud detection
- 20+ year of experience in FWA detection
- Familiarity with Appian
- Experience with Public Sector Clients (US Federal, Higher Education, State and Local Governments)
Required profile
Experience
Industry :
Information Technology & Services
Spoken language(s):
English
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