Opportunity Description
**Job Description**
**Job Summary**
Provides senior level support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA). Responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care, and recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence.
**Essential Job Duties**
• Responds to allegations of potential fraud, waste and abuse (FWA); conducts the investigation of fraudulent, wasteful and abusive activities involving members and providers.
• Analyzes enrollment data, medical claims data, contract terms, financial records, provider and member claims history, and other documentation to determine FWA and identify potential patterns.
• Appl...
**Job Summary**
Provides senior level support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA). Responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care, and recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence.
**Essential Job Duties**
• Responds to allegations of potential fraud, waste and abuse (FWA); conducts the investigation of fraudulent, wasteful and abusive activities involving members and providers.
• Analyzes enrollment data, medical claims data, contract terms, financial records, provider and member claims history, and other documentation to determine FWA and identify potential patterns.
• Appl...
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