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Analyst, Investigator (Aetna SIU)
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Job Description
- Req#: R0629413
Employer Industry: Healthcare Solutions
Why consider this job opportunity:
- Salary up to $93,574.00
- Eligible for a bonus, commission, or short-term incentive program in addition to base pay
- Comprehensive benefits package, including affordable medical plans, 401(k) with company matching, and employee stock purchase plan
- Access to no-cost wellness programs, confidential counseling, and financial coaching
- Opportunities for professional development and education assistance
- A commitment to creating a workplace where every colleague feels valued and included
What to Expect (Job Responsibilities):
- Conduct investigations to prevent, investigate, and prosecute healthcare fraud and abuse
- Communicate with law enforcement agencies regarding fraud cases
- Investigate and prevent payment of fraudulent claims from various parties
- Facilitate recovery of funds lost due to fraud
- Document case activities in tracking systems and prepare cases for review
What is Required (Qualifications):
- Must be located in Maryland
- Over 3 years of experience in healthcare fraud, waste, and abuse investigations and audits
- Strong analytical, research, verbal, and written communication skills
- Proficiency in Word, Excel, and database search tools
- Ability to travel and participate in legal proceedings
How to Stand Out (Preferred Qualifications):
- Credentials such as a certification from the Association of Certified Fraud Examiners (CFE)
- Accreditation from the National Health Care Anti-Fraud Association (AHFI)
- Billing and Coding certifications such as CPC (AAPC) and/or CCS (AHIMA)
- Knowledge of the employer's policies and procedures
#HealthcareFraud #HealthcareSolutions #CareerOpportunity #CompetitivePay #ProfessionalDevelopment
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