Associate Investigator

Highmark Health

**
Knowledge of provider facility payment methodology
Proficiency in claims processing systems and coding
Ability to testify in court of law
** Highmark Health is seeking an Associate Investigator to develop and maintain an anti-fraud program, conduct investigations, and ensure compliance with regulations related to fraud, waste, and abuse. The role requires strong analytical and communication skills, as well as experience in healthcare or finance, with a focus on auditing and investigative work. **

Job Summary

  • The incumbent is responsible for developing and maintaining an anti-fraud program which includes the development and delivery of training and filing of Fraud Plans and Reports.
  • This role involves conducting investigations into alleged fraud, waste, and abuse perpetrated by providers, members, facilities, pharmacies, groups, and employees.
  • The position requires the ability to testify in a court of law, prepare cases for referral to law enforcement entities, and coordinate the recovery of misappropriated funds.

Matching Summary

Match Score: 75

** Highmark Health is seeking an Associate Investigator to develop and maintain an anti-fraud program, conduct investigations, and ensure compliance with regulations related to fraud, waste, and abuse. The role requires strong analytical and communication skills, as well as experience in healthcare or finance, with a focus on auditing and investigative work. **

Skills & Requirements

Must-have

  • Knowledge of provider facility payment methodology
  • Proficiency in claims processing systems and coding
  • Ability to testify in court of law
  • Experience conducting field investigative work
  • Understanding of technical and financial aspects of health insurance

Nice-to-have

  • Strong relationship building skills
  • Strategic problem-solving capabilities
  • Self-starter working under pressure
  • Client-focused business acumen
  • Innovative problem-solving capabilities

Key Requirements

  • Associate's Degree required (Bachelor's preferred)
  • 1 year experience in Healthcare, Finance, or Provider office
  • Preferred certifications: CFE, CPC, COC, or AHFI

Work Rights

Not specified

Tailored Resume

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