Saturday , April 20 2024

Federal Law Enforcement Jobs in Miami – Health Fraud Investigator

Website Federal Law Enforcement

Job Description:

We are recruiting for a Health Fraud Investigator with a Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator background to support claims for review for  Medicare, Medicaid, and other claims data. Qualified candidates will have experience conducting in-depth evaluation of claims and making field level judgments related to investigations for potential Medicaid and/or Medicare fraud, waste and abuse investigations. This position requires knowledge of acceptable criteria for referral to the Centers for Medicare and Medicaid for administrative action or to the OIG for criminal action.

Job Responsibilities:

  • Identifying opportunities to improve processes and procedures.
  • Providing a high level of customer service with internal and external communications.​
  • Maintaining information files and chain of evidence (identifying, collecting, preserving) and analyzing and summarizing evidence for supporting documentation of claims.
  • Examining records, verifying authenticity of documents, and providing information to support the preparation of attestations/referrals or supervising the preparation of attestations/referrals, as needed.
  • Reviewing and referring potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee.
  • Utilizing leads provided by the investigative team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination.
  • Initiating and maintaining communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
  • Drafting investigation reports, evaluates investigation reports, and promotes effective and efficient investigations.
  • Testifying at various legal proceedings, as necessary.
  • Determining investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.
  • Conducting interviews of witnesses, informants, and subject area experts and targets of investigations.

Job Requirements:

  • Computer skills and experience with computer data entry and reporting systems.
  • Experience working with different software applications and ability to quickly learn and use new systems.
  • Ability to process information and use apply basic math concepts.
  • Ability to problem solve and provide resolution for complex issues.
  • Experience working with information from multiple sources and ability to communicate with team members to receive and convey information in different formats including written, oral, diagrams, schedules, and forms.
  • Demonstrated ability to work independently, follow processes and instructions, manage workload, and provide regular status/updates to supervisor(s).
  • Ability to effectively communicate information with team members and others, as required.

Qualification & Experience:

  • Reliable internet connectivity.
  • Experience reading, analyzing, and interpreting information and preparing reports and other business correspondence.
  • Experience responding to inquiries and providing information and resolution.
  • Experience supporting a state or federal program conducting healthcare fraud investigations.
  • Commitment to providing excellent customer service communicating with internal and external customers including the general public.
  • Experience in healthcare fraud investigation/detection.
  • Experience working with CMS, State Medicaid, OIG/FBI, or similar agency.
  • Expertise in reviewing and analyzing investigation data and make determinations.

Job Details:

Company: Federal Law Enforcement

Vacancy Type:  Full Time

Job Location: Miami, FL, US

Application Deadline: N/A

Apply Here