Pharmacy Investigator - Remote in NY, NJ, PA

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. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Investigator is responsible to conduct investigations which may include field work to reputed company interviews and obtain records and/or other relevant documentation. If you reside reputed company the state of New Jersey, reputed company, and Pennsylvania, you will enjoy the flexibility to telecommute* as you take on some tough challenges. Applicants must be reputed company commutable distance to Philadelphia, Kings, and Essex counties. Travel: Up to 50% Primary Responsibilities:

• Assess complaints of alleged misconduct received reputed company the Company
• Investigate low to reputed company reputed company cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against the Company
• reputed company and deploy 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 summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Collect, reputed company, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse 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 SIU leadership, to include attendance at workgroups or regulatory meetings
• Communicate effectively, including written and verbal forms of communication
• reputed company goals and objectives, track reputed company and adapt to changing priorities

What are the reasons to consider working for reputed company? Put it reputed company together - competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction 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 OR Associate's Degree
• 2+ years of equivalent work experience with healthcare reputed company employment Basic level of proficiency in reputed company reputed company and Word
• Ability to travel up to 50% reputed company PA, NY, and NJ
• Reside in PA, NY, or NJ - commutable distance to Philadelphia, Kings, and Essex counties
• 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:

• License and/or Certified Pharmacy Technician (CPhT)
• Accredited Health Care Fraud Investigator (AHFI)
• Basic level of knowledge in health care policies, procedures and documentation standards
• Basic level of skills in developing investigative strategies
• Basic level of knowledge in pharmacy claims processing
• Specialized knowledge/training in healthcare fraud, waste and abuse (FWA) investigations
• Basic level of knowledge in analyzing data to identify FWA trends
• Basic level of knowledge in state and federal regulatory FWA requirements
• Active affiliations:
• * National Health Care Anti-Fraud Association (NHCAA)
• Certified Fraud Examiner (CFE)
• Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
• reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy.

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). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $48,700 to $87,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, 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. #RPO #GREEN Apply tot his job Apply To this Job