Medica
Post Payment - Payment Integrity Investigator III
This job is now closed
Job Description
- Req#: POSTP004320
Employer Industry: Healthcare Insurance
Why Consider this Job Opportunity:
- Competitive pay up to $[highest pay] per hour
- Opportunity for career advancement and growth within the organization
- Remote work opportunity with the flexibility to work from any state where Medica is an employer
- Engaging in meaningful work that contributes to the detection and prevention of healthcare fraud and abuse
- Collaborative work environment with the Special Investigations Unit (SIU)
- Utilizing advanced analytics and problem-solving skills to conduct reviews and investigations
What to Expect (Job Responsibilities):
- Triaging, investigating, and resolving instances of healthcare error, waste, and abusive conduct
- Conducting provider claim and/or clinical reviews to gather and analyze necessary information
- Documenting relevant findings and working with the SIU as appropriate
- Analyzing healthcare claims data and conducting root cause analysis
- Knowledge of claims processing and provider billing
What is Required (Qualifications):
- High School Diploma or equivalent
- 3+ years of claims analysis and payment integrity related work experience
- Direct experience working in Fraud/Waste/Abuse, SIU, Payment Intent, and/or Payment Integrity
- Demonstrated experience in analyzing healthcare claims data and conducting root cause analysis
- Knowledge of claims processing and provider billing
How to Stand Out (Preferred Qualifications):
- Strong analytic and problem-solving ability
- Strong attention to detail including analytical and decision-making skills
- Ability to work independently as well as collaboratively as part of a team
- Demonstrated written and verbal communication skills
#HealthcareInsurance #RemoteWork #CareerAdvancement #AnalyticalSkills #CollaborativeEnvironment
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Offering health insurance plans in IA, MN, KS, MO, NE, ND, OK, SD, and WI. Includes group, individual and family, Medicaid, and Medicare plans.
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