Job Description: Conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices. Job Responsibilities: Makes referrals, both internal and external, in the required timeframe Exhibits behaviors outlined in Employee Competencies Investigates to prevent payment of fraudulent claims committed by insured’s, providers, claimants, customer members, etc* Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company* Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse* Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations Documents all appropriate case activity in tracking system Researches and prepares cases for clinical and legal review Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases* Provides input regarding controls for monitoring fraud related issues within the business units* Conducts investigations of known or suspected acts of healthcare fraud and abuse* Maintains open communication with constituents within and external to the company* Job Requirements: Proficient in researching information and identifying information resources. Knowledge of Aetna’s policies and procedures Ability to interact with different groups of people at different levels and provide assistance on a timely basis. Proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information. Strong analytical and research skills. Strong customer service skills. Strong verbal and written communication skills. 1-3 years Healthcare Fraud Investigation Experience 1-3 years Healthcare Insurance Experience Ability to utilize company systems to obtain relevant electronic documentation. 1-3 years Medicaid or Medicare Experience Job Details: Company: Aetna Vacancy Type: Full Time Job Location: Baton Rouge, LA, US Application Deadline: N/A Apply Here vacanciesforyou.net
Vacancies For You | Latest Job Opportunities 2025
