• Job Description

  Req#: R0002073

  We’re excited you’re considering joining a great place to work!

  Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law.

  
  About this Position

  Texas Mutual, a Best Company to Work for in Texas, is the leading provider of workers’ compensation insurance in the state, serving 70,000 business owners, 1.5 million workers and 5,000 agents. Our Special Investigations Department protects ourassets by investigating allegations of premium, healthcare, and claimant fraud against the company. We partner with internal departments, stakeholders and regulatory agencies to conduct appropriate investigations.
  We are recruiting for an Investigator in our health care fraud and abuse unit, which investigates allegations of health care fraud and abuse and providing support on administrative actions and criminal litigation efforts. This unit supports mission-critical functions, including provider claim reviews, identifying trends in healthcare fraud and reducing losses due to abusive and fraudulent billing. As an Investigator, you will gather evidence, conduct interviews, prepare investigative reports and testify in formal hearings.

  Responsibilities & Qualifications

  Essential Job Functions:

  In this role, you can expect to:

  • Investigate healthcare providers and attorneys suspected of fraudulent billing or other violations.

  • Conduct complex investigations using data analysis and other investigative techniques.

  • Interview witnesses and healthcare providers suspected of fraud or abuse.

  • Maintain accurate investigation activity notes.

  • Respond to request from State and Federal entities.

  • Negotiate recovery of funds paid to providers due to fraudulent billing, mistake of billing, or abuse.

  • Conduct on-site audits of provider records ensuring appropriate billing practices.

  • Organize evidence, documentation from interviews, and independent research to communicate recommendations to internal and external parties.

  • Compose investigative reports for referrals to prosecuting or other authorities.

  • Testify and present evidence at grand jury hearings and other judicial or administrative proceedings.

  Required Qualifications:

  • Bachelor's degree or equivalent education, training, or experience.

  • 0+years of investigative experience for Level I; 2+ years of investigative experience for Level II or equivalent education, training, or experience.

  • Highly experienced (at least at Level II) investigators located outside of the Austin area will be considered.

  • Valid Texas drivers’ license or available alternate means of transportation.

  Preferred Qualifications:

  • Certified Fraud Examiner (CFE) credential.

  • Proficient with Microsoft Word.

  • Strong writing skills.

  • Strong communication skills.

  • Experience and knowledge of healthcare billing and healthcare fraud schemes.

  • Knowledge of insurance industry with workers’ compensation preferred, the Texas Penal Code, the Code of Criminal Procedure, Texas Insurance Code, and Texas Workers’ Compensation Act.

  Texas Mutual Pay Transparency

  The base pay range is based on the market evaluation of the job and may include pay for multiple levels. Individual base pay within the range is determined by a variety of factors, including experience, performance, education, and demonstration of skills and competencies required for each role. Your recruiter can discuss the full value of our total compensation package with you, including our generous bonus plans and flex-hybrid work model.
  

  Base Pay Range: $28.98 - $90,093.15 Per Year

  Flex-Hybrid Work Environment:

  Texas Mutual’s flex-hybrid schedule allows you to bring your best self to work by working remotely and collaborating in the office based on business needs. All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed.

  Our Benefits:

  • Annual performance bonus and merit-based pay increase

  • Lifestyle Savings Account ($1,000 per year)

  • Automatic 4% employer contribution to retirement plan

  • 401k plan with 100% employer match up to 6%

  • Student loan repayment matching in 401k plan

  • Three weeks’ time off for vacation

  • Nine paid holidays and two personal days each year

  • Day one health, Rx, vision and dental insurance

  • Life and disability insurance

  • Flexible spending account

  • Pet insurance and pet Rx discounts

  • Free on-site gym, fitness classes, and health and wellness resources

  • Free identity theft protection

  • Free student loan repayment and refinancing consultation

  • Professional development and tuition reimbursement

  • Employee referral bonus

  • Free onsite snacks

• About the company

  We are the state's leading workers' compensation provider. See why over 70,000 business owners rely on us to meet the needs of their 1.5 million Texas workers every day.

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