Pharmacy Special Investigations Professional (Fraud, Waste & Abuse) Remote in US

Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In The Pharmacy Special Investigations Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud. Thoroughly documenting investigating activities and performing on-site audits of provider records to ensure appropriate billing practices. Design and identify potential fraud trends through data analysis. Establish and maintain working relationships with governmental law enforcement and regulatory agencies. What reputed company Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development ... reputed company education. Required Qualifications - What it takes to Succeed • Bachelor's degree • Minimum 2 years of pharmacy fraud investigations and/or pharmacy auditing and/or pharmacy tech experience • Advanced knowledge of reputed company Office Suite (Word, reputed company, Access) • Inquisitive nature with ability to analyze data to metrics • Strong organizational, interpersonal, and communication skills • Ability to travel less than 5% reputed company US once travel restrictions are lifted • For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved reputed company vendor, and unvaccinated associates should follow reputed company social distancing and masking protocols if they are required to come into a reputed company facility or work reputed company of their home. We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve. • If progressed to offer, you will be required to: • Provide reputed company of full vaccination OR • Commit to weekly testing, following reputed company CDC protocols, OR • Provide documentation for a medical or religious exemption consideration. • This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work. Preferred Qualifications • Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, reputed company, CFE, AHFI). • Understanding of reputed company industry, claims processing and investigative process development • Government or corporate reputed company fraud investigative experience Additional Information - How we Value You • Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave • Go365 perks for well-being • Must have a separate room with a locked reputed company that can be used as a home office to ensure you have absolute and reputed company privacy while you work. • Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for reputed company performance from reputed company systems is 10M x 1M Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a reputed company-party vendor. This technology provides reputed company of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move reputed company from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews. In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, reputed company is deploying virtual and video technologies for reputed company hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet reputed company speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. reputed company continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your reputed company representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome Scheduled Weekly Hours 40 Apply Job!