Conducts investigations and research relating to preventing, detecting and correcting fraud, waste and abuse (FWA) in all lines of business. Maintains a caseload and performs activities relating to intake, triage, planning, conducting, reporting and closing investigations.
Competencies and Skills:
Curious, detail-oriented and inquisitive mindset. *
Organizational and time management skills, along with an ability to skillfully handle time-sensitive projects.
Analytical, problem-solving and decision-making skills to work through challenging and complex case details. *
High degree of integrity and confidentiality required for handing information that is personal and confidential.
Strong written and verbal communication skills, including the ability to obtain information from others and deliver information in a concise, clear, and accurate manner.*
The ability to navigate and understand claims data and various databases to identify and document suspected FWA.*
Ability to work collaboratively, build coalitions and resolve conflicts, including success in managing cross-functional initiatives. *
Interpersonal skills, with the ability to listen, coach, and provide technical direction to others and to interact with tact and professionalism with all levels of the organization and external contains.*
No adverse actions pending or taken against him/her by any State or Federal licensing board or program.
Education and/or Experience:
Bachelor’s degree in criminal justice, legal systems, a healthcare specialty, or a related field is required.
Minimum two years of experience working in a SIU, law enforcement, insurance investigations, or a related field is required.
Prior work experience collaborating with FBI, HHS-OIG, Assistant U.S. Attorneys, MFCUs or State Attorney Generals preferred.
Designation/certification in one or more of the following is preferred: Accredited Healthcare Fraud Investigator (AHFI), Fraud Claims Law Specialist (FCLS), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI).
Working Conditions/Physical Demands:
Ability to work during peak periods.
Work is normally performed in a typical interior/office work environment.
Occasional bending and lifting up to 10 lbs may be required.
Ability to travel to facilities that are part of the Plan partnership.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.