Associate Health Insurance Investigator
Baltimore, Maryland
Experience: 3
Category: Healthcare
Brand: ALTA IT Services
Job ID: 319099
Date Posted: 04/23/2024
Shortcut: http://jobs.systemone.com/zPILKP
ALTA IT is hiring an
Associate Investigator to support a leading health insurance customer. The individual will work with the Special Investigations Unit (SIU) to assist in the reduction and recuperation of losses. You will research and analyze data using company anti-fraud software, Excel, and other tools to proactively identify new potential cases.
Pay: $32/HR
Location: Baltimore, MD (Hybrid) twice a week
Job Duties:
- Research provider/subscriber claims activity, operations manuals, data systems, medical policies, job duties and group benefit contracts to identify control deficiencies and non-compliance.
- Conduct preliminary research to gather evidence for the investigators.
- Determine if an individual's information is different than the information provided.
- Mail out letters to individuals to obtain information to determine if they're fraudulent.
- Prepare documentation needed to determine if an individual has committed fraud for the investigators.
System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, and MOUNTAIN, LTD., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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