Sr Fraud Investigator Job Listing at HCSC in Richardson, TX (Job ID R0033144)

Description

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is  invested in your future!

Job Summary This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery and litigation. Also, reviews operational controls, and claim system controls and protocols, and recommends enhancements to reduce the potential for fraud.

JOB REQUIREMENTS:
* Bachelor's Degree
* 5 years law enforcement experience (local, state, or federal) or 3 health care fraud investigative experience.
* Familiarity with laws applicable to health care fraud.
* Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
* Ability to independently prepare reports of interview and other documentation accurately reflecting investigative activity and results.
* Clear and concise verbal and written communication skills.

PREFERRED REQUIREMENTS:
* Accredited Health Care Fraud Investigator
* Certified Professional Coder
* Certified Fraud Examiner
* Knowledge of health care claims processing and benefit administration.

*Please note that this role is HYBRID with an in office requirement of 3 days a week and NO VISA sponsorship is available for this role.

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HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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