Fraud Investigation Technician 2

Profile

Description

The Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Fraud Investigation Technician 2 is a key role in helping perform audits within the Autism Care Demonstration (ACD). The technician assists with claims review, provider record updates, and audit preparation as defined by the TRICARE Operations Manual (TOM), Chapter 18, Section 4.

30% Assist with submission of claims corrections and recoupments, while monitoring of providers placed into prepayment status.

30% Update systems with corrections to provider records and verify updates are complete.

15% Manage internal correspondence control numbers. Request medical records. Print and prepare audit folders. Update the web application tracking system.

15% Research provider records - licenses, contracts, certification files and websites.

10% Special projects as assigned by leadership.

Our Department of Defense Contract requires U.S. citizenship for this position .

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .

Required Qualifications

Our Department of Defense Contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Experience coordinating activities of diverse functions

Excellent written and oral communication skills

Proficient with Microsoft office products to include Word, Excel and Outlook

Work at Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work

Must provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

2 plus years of healthcare experience

Prior experience in Fraud, Waste and/or Investigation

Bachelor's or Master's Degree in Business, Healthcare Administration or related field

Managed Care experience

Experience in TRICARE or other Federally regulated healthcare programs

Additional Information

Work Style : Remote

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward 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 via 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 to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com