McLaren Health Care · 23 hours ago

Special Investigative Unit Auditor, IN - Remote, Indiana Residency Required

Indianapolis, IN

Full-time

Remote

Mid Level

3+ years exp

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Responsibilities

Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products for assigned Plan.

Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Compliance experienceHMO knowledgePPO knowledgeRHIT certificationRHIA certificationAHFI certificationCFE certificationCPMA certificationCPC certificationStatistical courseworkBusiness degreeHealth care degree

Required

Associate Degree in business, health care or related field.

Three (3) years’ experience in progressively more responsible positions using analytical skills with at least two (2) years’ experience in compliance or related function.

Preferred

Bachelor’s Degree in business, health care or related field.

Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC.

Two (2) years’ experience and knowledge of HMO, or PPO (e.g. accounting/finance, reinsurance, regulatory compliance, claims processing, membership/eligibility, and actuarial precepts).

Course work or work experience in statistics.