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- Initiate claim adjustments, voucher deducts, and voluntary refunds in order to recover funds. Record recoveries and savings following established processes.
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Special Investigations Unit - Baltimore, MD, United States - Dexian - DISYS
Description
Position: Special Investigations Unit (SIU) Investigator
Location: Owings Mills MD (Hybrid)
Job Type: 6 months Contract - Possible extension
Job Description:
Job Duties: The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses through the detection, investigation, and resolution of low to medium levels fraud, waste, and abuse schemes, resulting in the savings and recovery of funds
Responsibilities:
Qualifications:
Education Level: Bachelor's Degree
Experience: 2 years insurance, investigative, health care, nursing or law enforcement. In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the
required work experience.
Preferred Qualifications:
Credential in a health care or investigations related area such as Certified Fraud Examiner (CFE),
Accredited Health Fraud Investigator (AHFI), RN/LPN, or Certified Professional Coder (CPC).
Knowledge of ICD 10 and CPT Codes, medical terminology, extensive training in claims and subscriber customer service methods, and previous experience in the health care industry.
Knowledge, Skills and Abilities (KSAs):
Knowledge of laws that pertain to public and insurance funds - Proficient
Excellent communication skills both written and verbal. - Proficient
Ability to recognize, analyze, and solve a variety of problems. - Proficient
Ability to maintain effective interpersonal relationships - Proficient
Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.
Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit to learn more.
Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.