Company
Finance
SpecialInvestigator
“Special Investigator. Skills: Investigations, Fraud detection, Data analysis. Conduct internal and external investigations. Ensure payment integrity”
What You'll Achieve.
Deter, detect, prevent and recover losses; Reduce or eliminate Medicare Part C and D benefit costs; Reduce or eliminate fraudulent and abusive claims paid for with federal dollars
Industry & Context.
Analytical position; Identify root-cause problems
Ability to travel 20% to 40%, National travel required, Overnight travel required, Conduct interviews face-to-face, Assess body language, Valid Driver Licence, Good driving record, Use of automobile that is properly licensed and insured, Background check, Pre-employment drug screening, Records verification, Criminal court checks, Federal, state, county criminal record checks, DMV checks, Credit bureau checks, Prohibited from working in insurance industry if convicted of felony crime involving dishonesty or breach of trust without written consent, Drug Free Workplace
What They're Looking For.
Must Have
Bachelor's in Audit, Accounting, Criminal Justice, Nursing or related field, Four years of related experience in lieu of Bachelor's degree, 3 years experience in analytical position related to fraud investigations, audits, medical procedures or coding, Proficient computer skills, Knowledge of Microsoft programs, Approved certification or medical license (CIA, CPA, CFE, CISA, POST, RN, LPN or other business or clinical licensures), Valid Driver Licence, Good driving record, Use of automobile that is properly licensed and insured
Nice to Have
Residency in or relocation to Louisiana, CFA charterholder preferred
What You'll Do.
Conduct internal and external investigations
Ensure payment integrity
Provide management insights and recommendations
Comply with laws and regulations
Perform high-quality investigations
Gather and analyze data
Collect and preserve evidence
Prepare cases for referral
Testify in legal proceedings
Document investigation stages
Prepare post-investigative reports
Handle confidential information
Participate on special projects
Reduce Medicare costs
Reduce fraudulent claims
Refer illegal drug activity
Conduct case development
Support NBI MEDIC and law enforcement
Assist law enforcement
How You'll Work.
Team & Collaboration
Partner with assigned analyst(s); Delegate activities to Analysts and team members; Work with external consultants, attorneys, auditors, agencies, law enforcement
Communication Scope
Excellent communication; Negotiation; Interrogation
Process & Methodology
Manage time, Manage cases
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