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Health Care/Attorney/In House/Canton, Ohio

Canton OH Senior Investigator The candidate will be responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices on an enterprise wide basis for company's Special Investigations Unit. Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintains up-to-date case files for management review. Prepare final report and notification of findings letter suitable for dissemination to provider and counsel. Presents providers offers for settlement to supervisor for approval. Communicates orally and in writing with all customers, internal and external, regarding findings. Assists in the development of policy and/or procedures to prevent loss of company assets. Prepares and delivers presentations of findings to internal and external entities. Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts. Represents company in court proceedings regarding investigations.

The candidate should have B.A./B.S. degree and 3-5 years of related experience, preferably in healthcare or white collar crime investigation, or equivalent combination of education and experience. J.D. degree or law enforcement experience preferred. Professional certification of CFE, CPC, AHFI or other job related designation preferred, or any combination of education and experience, which would provide an equivalent background. In-depth knowledge of fraud, waste and abuse management needed. Healthcare information technology experience essential.
Legal 3 - 5 Full-time 2013-09-04
 
Health Care/Attorney/In House/Canton, Ohio
Refer job# HLNU34453
 
Senior Investigator The candidate will be responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices on an enterprise wide basis for company's Special Investigations Unit. Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintains up-to-date case files for management review. Prepare final report and notification of findings letter suitable for dissemination to provider and counsel. Presents providers offers for settlement to supervisor for approval. Communicates orally and in writing with all customers, internal and external, regarding findings. Assists in the development of policy and/or procedures to prevent loss of company assets. Prepares and delivers presentations of findings to internal and external entities. Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts. Represents company in court proceedings regarding investigations.

The candidate should have B.A./B.S. degree and 3-5 years of related experience, preferably in healthcare or white collar crime investigation, or equivalent combination of education and experience. J.D. degree or law enforcement experience preferred. Professional certification of CFE, CPC, AHFI or other job related designation preferred, or any combination of education and experience, which would provide an equivalent background. In-depth knowledge of fraud, waste and abuse management needed. Healthcare information technology experience essential.
 
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