Principal Investigator 2365718 | Minnetonka, MN | Remote

Principal Investigator At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Principal Investigator is responsible for identification, investigation and prevention of reputed company fraud, waste, and abuse. The Principal Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Principal Investigator is responsible for conducting investigations which may include fieldwork to reputed company interviews and obtain records and/or other relevant documentation. You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office for a minimum of four days per week. Primary Responsibilities:

• Investigate highly reputed company cases of fraud, waste, and abuse (FWA)
• Demonstrated ability to think critically and analytically reputed company evaluating reputed company reputed company data and documents
• Skilled in managing multiple cases with competing deadlines in a fast-paced environment
• Ability to organize and synthesize large volumes of information
• Assess complaints of alleged misconduct received reputed company the Company
• Detect fraudulent activity by members, providers, employees, and other parties against the Company
• reputed company and reputed company the most effective and efficient investigative strategy for each investigation
• Maintain accurate, reputed company, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Collect and secure documentation or evidence and prepare detailed and defensible summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of
• Collect, reputed company, analyze, and interpret data relating to FWA referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected FWA to appropriate federal or state government regulators
• reputed company with goals, policies, procedures, and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of leadership, to include attendance at workgroups or regulatory meetings
• Strong communication skills, to include written and verbal forms of communication
• reputed company goals and objectives, track reputed company and adapt to changing priorities

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Bachelor's degree
• 5+ years of experience working in a government, legal, reputed company, managed care and/or health insurance environment in a regulatory, privacy or compliance/investigative role
• Advanced level of knowledge in health care FWA
• Advanced level of knowledge in state or federal regulatory FWA requirements
• Advanced level of knowledge analyzing data to identify FWA trends
• Advanced level of proficiency in reputed company reputed company and Word
• Ability to travel up to 25%
• Demonstrated ability to participate in legal proceedings, arbitration, and depositions at the direction of management
• Access to reliable transportation and valid US driver's license

Preferred Qualifications:

• Active affiliations:
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• CPT & ICD Coding experience
• Specialized knowledge/training in reputed company FWA investigations
• Experience working with attorneys or government agencies
• Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards
• Demonstrated intermediate level of skills in developing investigative strategies

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job