Investigator, Fraud Risk Management
Tasks
- Analyze data to identify fraud trends
- Conduct plan member interviews
- Conduct service provider interviews
- Detect fraud schemes
- Investigate fraud and abuse cases
- Maintain investigation databases and logs
- Perform on site audits of service providers
- Prepare court and complaint case documentation
- Prepare documentation for plan sponsors police and management
- Prepare investigation reports
- Recommend process improvements for investigations
- Respond to fraud inquiries and escalations
- Stay current on fraud trends and schemes
Perks/Benefits
Skills/Tech-stack
Adobe Acrobat | Audit | Case preparation | Court Case Preparation | Data analytics | Excel | Fraud investigation | Interviewing | Legal documentation | Lotus Notes | Medical terminology | Microsoft Word | Negotiation | Outlook | PowerPoint | Report Writing | Risk Management | Stakeholder management | Tableau
Education
Bachelor of Arts | Bachelor of Engineering | Bachelor of Science | Master of Science
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