Global Healthcare Fraud Investigator
We are actively seeking a Global Healthcare Fraud Investigator! The fraud investigator is on the front line of GeoBlue's effort to reduce unnecessary medical costs and make healthcare more affordable for our customers around the globe.
The investigator is responsible for the end-to-end investigation process on known or suspected acts of fraud and abuse on healthcare claims around the globe, from information gathering and interviews to financial recoveries and law enforcement collaboration.
Responsibilities:
Evaluate and gather information related to cases of known or suspected fraud.
Analyze historic claims to determine the full scope of identified fraudulent activity.
Develop an investigation strategy for each case to assist in timely and successful resolution.
Conduct interviews/interrogations with customers, providers, witnesses, authorities, and other people involved in the case.
Document your activities in a logical, clear, and concise format, concluding with a comprehensive written investigation report.
Facilitate the recovery of fraud and abuse related overpayments of company and customer funds.
Collaborates with law enforcement agencies as appropriate, including potentially testifying to investigation details in court.
Researches and prepares information for management and client reporting.
Coordinate activities across other departments (ex.
Clinical, Legal, Provider Finance, Global Service Center, Claims) and external entities (ex.
Blue Cross Blue Shield home plans, law enforcement).
Partner with legal and compliance to ensure all state, federal, and international requirements for investigations and fraud reporting are adhered to.
Identify and deliver on continuous improvement opportunities.
Additional Responsibilities May Include:
Develop process documentation for new and existing processes.
Develop and deliver training to internal and external teams.
Partner with IT to develop new and enhanced tools for fraud detection and investigation workflow management.
Other duties as assigned.
Requirements:
College degree or equivalent experience required.
Fraud examination certification or equivalent credentials highly valued.
Minimum 2 years of investigation experience or 4 years of insurance industry experience required; 5-7 years preferred.
Demonstrated experience conducting international health insurance fraud investigations strongly preferred.
Strong attention to detail and problem-solving skills.
Excellent written and verbal communication skills.
Strong organizational skills, with the ability to manage multiple competing tasks at the same time.
Ability to manage ambiguity and drive for resolution.
Multilingual strongly preferred.
Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).
Working Conditions:
Flexibility to work in an office and/or at-home, remote office environment.
Schedule flexibility is occasionally necessary in this position.
Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
Physical Demands:
Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.
Internal Pay Grade:
10The starting pay for this role is $66,023 to $84,179 based on skill level and experience in a similar role.
This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.
Recommended Skills Attention To Detail Business Process Improvement Claim Processing Clinical Works Communication Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
The investigator is responsible for the end-to-end investigation process on known or suspected acts of fraud and abuse on healthcare claims around the globe, from information gathering and interviews to financial recoveries and law enforcement collaboration.
Responsibilities:
Evaluate and gather information related to cases of known or suspected fraud.
Analyze historic claims to determine the full scope of identified fraudulent activity.
Develop an investigation strategy for each case to assist in timely and successful resolution.
Conduct interviews/interrogations with customers, providers, witnesses, authorities, and other people involved in the case.
Document your activities in a logical, clear, and concise format, concluding with a comprehensive written investigation report.
Facilitate the recovery of fraud and abuse related overpayments of company and customer funds.
Collaborates with law enforcement agencies as appropriate, including potentially testifying to investigation details in court.
Researches and prepares information for management and client reporting.
Coordinate activities across other departments (ex.
Clinical, Legal, Provider Finance, Global Service Center, Claims) and external entities (ex.
Blue Cross Blue Shield home plans, law enforcement).
Partner with legal and compliance to ensure all state, federal, and international requirements for investigations and fraud reporting are adhered to.
Identify and deliver on continuous improvement opportunities.
Additional Responsibilities May Include:
Develop process documentation for new and existing processes.
Develop and deliver training to internal and external teams.
Partner with IT to develop new and enhanced tools for fraud detection and investigation workflow management.
Other duties as assigned.
Requirements:
College degree or equivalent experience required.
Fraud examination certification or equivalent credentials highly valued.
Minimum 2 years of investigation experience or 4 years of insurance industry experience required; 5-7 years preferred.
Demonstrated experience conducting international health insurance fraud investigations strongly preferred.
Strong attention to detail and problem-solving skills.
Excellent written and verbal communication skills.
Strong organizational skills, with the ability to manage multiple competing tasks at the same time.
Ability to manage ambiguity and drive for resolution.
Multilingual strongly preferred.
Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).
Working Conditions:
Flexibility to work in an office and/or at-home, remote office environment.
Schedule flexibility is occasionally necessary in this position.
Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
Physical Demands:
Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.
Internal Pay Grade:
10The starting pay for this role is $66,023 to $84,179 based on skill level and experience in a similar role.
This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.
Recommended Skills Attention To Detail Business Process Improvement Claim Processing Clinical Works Communication Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
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