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SIU Coordinator (Hybrid)
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Full-time
- Triage and develops case leads for the department, using various data sources and employing statistical analysis and reporting skills.
- Track incoming fraud allegations from all sources for statistical purposes and enter cases accurately in Fraud, Waste and Abuse case management system.
- Monitor and notify SIU associates on dollar recovery and Corrective Action Plan status.
- Pursues low complexity and routine investigations of fraud and/or abuse theory approach analyses, provider and subscriber medical data, claims, and systems reports as required.
- Performs root cause analysis to identify control deficiencies, and/or non-compliance as relates to risk mitigation and effective external/internal controls for CareFirst Business Operations.
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