Job Details

This position is a remote position but West Virginia residency is required. Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud, waste, and abuse. Also reports suspected fraud, waste, and abuse to state and federal agencies as required by law and regulation. What you will do:Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business. Researches and prepares cases for clinical and legal review. Documents all appropriate case activity in case tracking system. Facilitates feedback with providers related to clinical findings. Initiates proactive data mining to identify aberrant billing patterns. Makes referrals, both internal and external, in the required timeframe. Facilitates the recovery of company and customer money lost as a result of fraud matters. Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and ab...Investigator, Healthcare, Fraud, Retail, Research