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Lead Investigator
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Full-time
- Develop and deliver trainings, materials, tools and templates to support SIU processes and enhance the knowledge and skills of FWA investigators including emerging trends, awareness of fraud schemes and investigative techniques.
- Develop and/or enhance FWA policies, procedures and guidelines for Investigative staff based on industry best practices, evolving fraud detection methodologies and regulatory requirements and laws impacting SIU operations.
- Perform vendor and vendor manager oversight, training and guidance to meet HMSA's FWA regulatory and reporting requirements.
- Initiate, analyze, develop, and resolve proactive FWA cases using Fraud Detection Software, advance/extensive knowledge of benefits, claims, rules, processes, and other relevant topics (e.g., medicine, pharmacy, law, accounting).
- Maintain extensive documentation and evidence for SIU cases.
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