Corporate Investigator I

Position Purpose

Responsible for investigating allegations of fraud, waste, or abuse against the company. Analyze data, obtain and review records from healthcare providers, interview suspects or witnesses, and prepare cases for administrative action and prosecution. Draft written reports of investigative findings. Maintain data for reporting purposes. Work with legal department and law enforcement agencies in the prosecution or civil regulation of fraud cases. Monitor corporate fraud hotline, web reports and Global Core inquiries. Assist new personnel in activities related to investigative techniques. Monitor restitution payments, track recoupments and savings activities and transfer refund payments received for investigations to the Treasury Department. Assist with the reporting of these tasks within the Special Investigations Unit. Assist in creating, updating and maintaining policies and procedures as required.

What You’ll Do

• Investigate allegations of fraud, waste, or abuse against the company.
• Analyze data, obtain and review records from healthcare providers, interview suspects or witnesses, and prepare cases for administrative action and prosecution.
• Draft written reports of investigative findings.
• Maintain data for reporting purposes.
• Work with legal department and law enforcement agencies in the prosecution or civil regulation of fraud cases.
• Monitor corporate fraud hotline, web reports and Global Core inquiries.
• Aid new personnel in activities related to investigative techniques.
• Monitor restitution payments, track recoupments and savings activities and transfer refund payments received for investigations to the Treasury Department.
• Assist with the reporting of these tasks within the Special Investigations Unit.
• Aid in creating, updating and maintaining policies and procedures as required.

Required Education

Bachelor's Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

Required Work Experience

• 2 years of fraud investigations or audit in health insurance or other regulatory industry, OR
• 2 years of law enforcement investigations experience, OR
• 3 years of experience in a health insurance claims operation.

Required Skills and Abilities

• Strong customer service orientation.
• Ability to effectively communicate both verbally and in writing to all levels throughout the organization.
• Excellent analytical or critical thinking skills.
• Ability to persuade, negotiate or influence.
• Ability to review, analyze, and develop information and make appropriate decisions.
• Ability to develop working knowledge of medical terminology.
• Ability to work independently and prioritize workload.
• Knowledge of insurance commission regulations.
• Ability to handle confidential or sensitive information with discretion.

Required Software and Other Tools

• Microsoft office.

Comprehensive Benefits Package

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

Equal Employment Opportunity Statement

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.