- This team is tasked with identification, remediation and prevention of fraud, waste and abuse resulting in savings and recovery of funds.
- This project is focused on BG research in enrollment fraud. Needs someone to come onboard and look through enrollment files.
- Remote in EST time zone OR on-site around 2 times per week in Baltimore and/or Owings Mills.
- Must have analytical skills, can do research, great with documentation and comm, great with MS office.
- Will have to do research to make sure members are who they say they are, living where they say they live, etc.
- Will be doing preliminary research for the actual Investigators.
- Preferred: Healthcare bg, compliance bg, data analytic bg,
- Will be one round of interview. Video conference
- Independently conduct low to medium level investigations and provide support as part of an assigned team to all levels (low to medium) investigations of suspected fraud, waste, and abuse. In conjunction with assigned team or management, develop and execute investigative plans that may include performance of audits of financial business records, provider and subscriber medical data, claims, systems reports, medical records, analysis of contract documents, provider/subscriber claims history, benefits, external data banks and other documents to determine the possible existence of fraud and/or abuse. Provide support for offsite audits/investigations and interviews when requested. Research provider/subscriber claims activity, operations manuals, data systems, medical policies, job duties and group benefit contracts to identify control deficiencies and non-compliance. Investigator will develop documentation to substantiate finding including formal reports, spreadsheets, graphs, audit logs, use of anti-fraud software and appropriately sourced reference materials. Must ensure audits and investigations are timely, effective and result in an overall achievement of unit goals.
- Investigator researches and analyzes claims data using company anti-fraud software, Excel, and other tools to proactively identify new potential cases. Investigator will develop documentation that supports conclusions, recommendations, and substantiates findings including formal correspondence, audit reports, spreadsheets, graphs, audit logs, anti-fraud software analysis, and appropriately sourced reference materials. Investigator ensures timely maintenance and organization of case file documentation with a high level of detail and accuracy that clearly and concisely outlines investigative steps, case synopses, and findings and to preserve as potentially discoverable material
- Initiate claim adjustments, voucher deducts, and voluntary refunds in order to recover funds. Record recoveries and savings following established processes.
- Perform special projects as assigned by management to meet the needs of the Special Investigations Unit.
-
Fraud Investigator
1 week ago
Dexian Baltimore, United StatesPosition: Fraud Investigator · Location: Baltimore OR Owings Mills MD (Remote/ Hybrid) · Job Type: 6 months Contract - Possible extension · Hiring Manager Notes: · This team is tasked with identification, remediation and prevention of fraud, waste and abuse resulting in savings ...
-
Asset Protection Specialist
1 day ago
7-Eleven, Inc. Baltimore, United StatesOverview: · **About This Opportunity** · Provide the 7-Eleven Field Operators with professional asset protection services. Conduct timely, comprehensive, accurate investigations and research in order to assure revenue and profit enhancement in a proactive manner. · **Responsibili ...
-
Surveillance Investigator
1 week ago
Veracity Research Company Baltimore, United StatesVRC Investigations is currently expanding our Surveillance Investigations division. Veracity Research Company Investigations (VRC), is one of the nation's leading and most experienced investigation companies. For 29 years, we have continued to commit ourselves to the utmost degre ...
-
Mia Insurance Commissioner
4 days ago
State of Maryland Baltimore, United States**Introduction**: · The Maryland Insurance Administration (MIA) is an independent State agency that is committed to providing fair treatment to consumers, and to the effective and efficient operation of insurance carriers and producers (agents). The MIA is passionate about increa ...
-
Assistant United States Attorney
1 week ago
US Executive Office for U.S. Attorneys and the Office of the U.S. Attorneys Baltimore, United States**Duties**: · The United States Attorney's Office prosecutes all federal criminal cases and represents the interests of the United States in civil cases in Maryland. The United States Attorney has two offices - the Northern Division located in Baltimore and the Southern Division ...
-
Health Occupations Investigator Ii
4 days ago
State of Maryland Catonsville, United States**Introduction**: · **THIS RECRUITMENTS LIMITED TO CURRENT STATE OF MARYLAND EMPLOYEES ONLY** · **GRADE**: · ASTD15 · **LOCATION OF POSITION**: · Maryland State Board of Dental Examiners · SGHC/Benjamin Rush Building · 55 Wade Avenue/Tulip Drive · Catonsville, MD 21228 · **POSITI ...
-
Administrator I
1 week ago
State of Maryland Catonsville, United States**Introduction**: · **THIS RECRUITMENTS LIMITED TO CURRENT STATE OF MARYLAND EMPLOYEES ONLY.** · **GRADE**: · 16 · **LOCATION OF POSITION**: · Maryland Board of Dental Examiners · SGHC/Benjamin Rush Building · 55 Wade Avenue/Tulip Drive · Catonsville, MD 21228 · **Main Purpose of ...
-
Security Specialist
2 days ago
Target Glen Burnie, United StatesStarting Hourly Rate / Salario por Hora Inicial: $18.50 USD per hour · **ALL ABOUT TARGET** · As a Fortune 50 company with more than 400,000 team members worldwide, Target is an iconic brand and one of America's leading retailers. · Working at Target means the opportunity to help ...
-
Special Investigations Unit
3 days ago
nTech Solutions, Inc. Baltimore, United StatesTerms of Employment · Contract, 6 Months · This position can either be 100% remote or hybrid – with candidates working a few days onsite in the Baltimore, MD or Owings Mills, MD office. · Candidates interested in remote work must reside in the Eastern Time Zone. · Overview ...
-
Associate Commissioner, Insurance Fraud
1 week ago
State of Maryland Baltimore, United StatesIntroduction · The Maryland Insurance Administration (MIA) is · an independent State agency that regulates Maryland's $46 billion insurance · industry and protects consumers by monitoring and enforcing insurers' and · insurance professionals' compliance with State law. Through th ...
-
Special Investigations Unit
3 days ago
Dexian - DISYS Baltimore, United States Full timePosition: 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 rec ...
-
Compliance Analyst
2 weeks ago
KMM Technologies Baltimore, United StatesJob Description · Job Description · Reach me on Tel: · |Email: · Position · : Regulatory Compliance Analyst · Location: Baltimore, MD · Duration: Long Term · Job Description : · The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and ...
-
Financial Administrator
6 days ago
Prince George's County Public Schools Prince George's County, MD, United States**Description**: · **Job Title** · Financial Administrator · **Location** · **Organization Name** · Office of Integrity and Compliance · **Department Description** · Under the direction of the Integrity and Compliance Officer, the Financial Administrator will assist with the day- ...
-
Regulatory Compliance Analyst
2 weeks ago
Lumen Solutions Group Inc. Baltimore, United StatesCompany Description · Lumen Solutions Group Inc. is a technology consulting Services Company based in Virginia. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in strategy de ...
-
H-E-B Spring, United States**Responsibilities**: · Essential Functions / Process Responsibilities include the following; other duties may be assigned · - Executes and follows through on all Loss Prevention, security, and safety programs in order to reduce shrink · - Develops and leads employee training and ...
-
investigator
1 week ago
State of Maryland Baltimore, United StatesIntroduction · The Attorney General is the Chief Legal Officer of the State of Maryland. The Office of the Attorney General (OAG) has the general charge, supervision, and direction of the State's legal business, acting as legal advisors and representatives of the major agencies, ...
-
Investigator unit
5 days ago
Dexian - DISYS Baltimore, MD, United StatesPosition: Special Investigations Unit (SIU) Investigator · Job Type: 6 months Contract - Possible extension · 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 ...
-
Special Investigations Unit
5 days ago
Dexian - DISYS Baltimore, MD, United StatesPosition: 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 r ...
-
Forensic Accounting Senior Manager
3 days ago
Withum Baltimore, United StatesLooking to join a firm with an unbeatable culture? · Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of Strength in today's modern business landscape. Withum empowers clients with innovative tools and solutions to ...
-
Manager- Internal Fraud- Vice President
1 week ago
Morgan Stanley Baltimore, United StatesThis Vice President will report to an Officer within the Fraud Department and will work closely with control partners, technology teams, and stakeholders across Cyber, Data, Risk and Resilience division to support, improve, and expand critical internal fraud alerts. Key areas of ...
Fraud Investigator - Baltimore, United States - Dexian
Description
Position: Fraud Investigator
Location: Baltimore OR Owings Mills MD (Remote/ Hybrid)
Job Type: 6 months Contract - Possible extension
Hiring Manager Notes:
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.
