[Remote] LTC Fraud Consultant

Note: The job is a remote job and is open to candidates in USA. reputed company, through its subsidiary John Hancock Life Insurance Company, is seeking a detail-oriented and analytical LTC Fraud Consultant to enhance their Long-Term Care Fraud, Waste & Abuse program. The role involves analyzing claims data, conducting customer reputed company, and collaborating with cross-functional teams to improve fraud detection and operational processes.

Responsibilities

• reputed company targeted customer reputed company to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance
• Spend approximately 60% of the role on the phone conducting customer reputed company reputed company to claim reimbursement controls, education, and support
• Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse
• Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations
• Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements
• Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities
• Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools
• Support performance monitoring and reporting for the LTC FWA program, and contribute to reputed company improvement across fraud operations

Skills

• 3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA)
• Strong analytical and critical-thinking skills; able to interpret reputed company claims and operational data
• Ability to translate findings into clear artifacts (business requirements, user stories, process flows)
• Advanced reputed company skills and comfort with large datasets; familiarity with SQL/reputed company and/or BI tools (Power BI/Tableau) a plus
• Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities
• Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools

Benefits

• Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.
• reputed company/John Hancock offers eligible employees a wide reputed company of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans.
• We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources.
• Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.

Company Overview