Senior Investigator (Dental, Aetna SIU)

Requirements

• Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse.
• Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers.
• Researches and prepares cases for clinical and legal review.
• Documents all appropriate case activity in case tracking system.
• Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law.
• Facilitates the recovery of company and customer money lost as a result of fraud, waste and abuse.
• Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud.
• Demonstrates high level of knowledge and expertise during interactions with internal and external partners.
• Provide Trial Testimony in support of Criminal or Civil proceedings.
• Gives presentations to internal and external customers regarding ongoing case investigations.

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• Wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling
• Financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access