Senior Fraud and Waste Investigator Job Summary
We are seeking a highly skilled Senior Fraud and Waste Investigator to oversee the monitoring and enforcement of our fraud, waste, and abuse (FWA) compliance program. The ideal candidate will have at least 2 years of healthcare fraud investigations and auditing experience.
Main Responsibilities:
* To carry out provisions of the compliance plan, including FWA policies and procedures.
* To investigate allegations of FWA and implement corrective action plans.
* To assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to relevant authorities.
* To coordinate across all departments to encourage sensible and culturally-competent business standards.
* To oversee internal investigations of FWA compliance issues.
* To work with other teams to create and implement tools and initiatives designed to resolve FWA contract compliance issues.
* To respond to FWA questions, problems, and concerns from stakeholders.
* To cooperate effectively with investigative agencies on FWA cases to ensure best outcomes.
* To adequately staff and manage the program integrity investigator(s) responsible for all FWA detection programs and activities.
* To assist in developing FWA education to train staff, providers, and subcontractors.
Key Skills and Qualifications:
* Must reside in Ohio.
* At least 2 years of healthcare fraud investigations and auditing experience.
* Knowledge of healthcare payment methodologies.
* Strong organizational, interpersonal, and communication skills.
* Inquisitive nature with ability to analyze data to metrics.
* Computer literate (MS, Word, Excel, Access).
* Strong personal and professional ethics.
Work Style and Location:
This role is open to remote work with occasional travel to meetings or training sessions.
Why This Role Matters:
This Senior Fraud and Waste Investigator will play a critical role in preventing and detecting potential FWA activities, ensuring transparency and accountability within our organization.
What We Offer:
A competitive salary and benefits package, as well as opportunities for growth and development in a dynamic and caring community.