Managed Care Oversight Investigator I

North Carolina Department of Health and Human Services (DHHS)

Wake County, NC, United States
Recruitment range: $50,633 - $63,500; salary grade...
Hybrid
Medicaid program compliance
Investigate provider billing
Analyze member and provider data
The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network

Job Summary

  • The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.
  • This role supports the integrity of state healthcare expenditures and promotes program compliance.
  • The State of North Carolina offers excellent comprehensive benefits, including health insurance, retirement plans, and paid leave.

Matching Summary

The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.

Salary

Recruitment Range: $50,633 - $63,500; Salary Grade Range: $52,592 - $92,036; Benefits: Not specified

Skills & Requirements

Must-have

  • Medicaid program compliance
  • Investigate provider billing
  • Analyze member and provider data
  • Fraud, waste, and abuse investigations
  • Managed care regulations

Nice-to-have

  • Collaborate with diverse stakeholders
  • Strong organizational skills
  • Effective communicator
  • Proficiency in Microsoft Office

Key Requirements

  • Master's degree and two years of related experience
  • Bachelor's degree and four years of related experience
  • Equivalent combination of education and experience
  • Ability to interpret regulations

Work Rights

Not specified

Tailored Resume

Cover Letter