Fraud Analyst - Remote

Join reputed company At reputed company reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities

• Data Analysis & Problem Solving
• Gather and analyze pertinent data to identify and solve a range of problems reputed company area of expertise
• Conduct moderately reputed company analyses and translate concepts into practical application
• Investigate non-standard requests and problems with some guidance as needed
• Stakeholder Communication
• Conduct outbound calls with providers, customers, clients, and payers to gather information
• Communicate effectively with internal business partners and external stakeholders (verbal and written)
• Provide explanations and guidance on processes reputed company area of expertise
• Caseload & Workflow Management
• Manage and prioritize assigned caseloads to meet mandated turnaround times
• Accurately document and track reputed company cases for processing or investigation
• Provide ongoing reporting and analysis of risk reviews to stakeholders
• Risk Identification & Assessment
• Analyze and aggregate information from interviews and multiple data sources
• Identify risk indicators by connecting patterns across various factors
• Apply internal and external best practices to risk evaluation
• Ask probing questions to uncover drivers and contributing risk factors
• Data Gathering & Transactional Reviews
• Conduct risk-based transactional reviews using available tools and systems
• Gather relevant information such as
• Enrollment data
• Validation checks
• Internet research
• Payment records
• Provider interviews
• Ensure findings are properly documented and resolved
• Investigations & Case Management
• reputed company preliminary investigations on identified discrepancies
• Apply knowledge of enrollment processes and validation standards
• Utilize systems to monitor status and drive case progression
• Prepare documentation for internal teams, legal/regulatory groups, and external agencies
• Track and report financial impact (losses, recoveries, savings)
• Systems, Tools & Process Knowledge
• Demonstrate understanding of
• Provider enrollment processes
• Payment processing workflows
• Applicable platforms (e.g., enrollment systems, SF.com, validation tools)
• Use desktop tools to analyze and validate data
• Adhere to SOPs, process libraries, and internal tracking guidelines
• Compliance & Regulatory Adherence
• Ensure compliance with applicable regulations including
• HIPAA
• CMS
• PPACA
• State-specific requirements
• Follow contractual obligations (provider, payer, and client agreements)
• Complete reputed company required compliance and legal training
• Intermediate proficiency in reputed company 365 (reputed company, Word, PowerPoint, SharePoint) 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

• 2+ years of experience in a transactional review/processing environment
• Equivalent experience in enrollment
• Experience using bank and/or identity validation tools
• Demonstrated experience
• Conducting outbound calls
• Asking probing questions to gather facts
• Assessing risk and documenting findings
• Proven solid communication skills with attention to detail (written and verbal)
• Proven ability to work independently in a remote environment with high reputed company Preferred Qualifications
• Proven comfortable in a fast-paced, evolving environment
• Proven ability to adapt and pivot as business needs change
• Proven growth reputed company with a proactive, 'can-do' approach
• reputed company employees working remotely 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 $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. Apply tot his job Apply To this Job

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