At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Description Summary This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery, and litigation. Also, review operational controls, claim system controls and protocols, and recommends enhancements to reduce the potential for fraud.

JOB REQUIREMENTS:

• Bachelor’s Degree
• 7 years’ law enforcement experience (local, state, or federal) or 7 years fraud investigative experience. Experience directing complex fraud investigations which result in criminal or civil prosecutions.
• Experience planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations.
• Familiarity with state and federal laws applicable to health care fraud.
• Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
• Ability to independently prepare reports of interview and other documentation accurately reflecting investigative activity and results.
• Clear and concise verbal and written communication skills.
• Self-motivated, results oriented with demonstrated leadership skills.

PREFERRED REQUIREMENTS:

• Accredited Health Care Fraud Investigator
• Certified Professional Coder
• Certified Fraud Examiner
• Medicare Advantage Experience

This is a Flex (Hybrid) role: 3 days in office; 2 days remote.

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Compensation: $69,800.00 - $125,900.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards