Medicare/Medicai Fraud Investigator

Job Category:Business Process
Primary Location:USA-NE: NEBRASKA-OMAHA
Schedule:Full-time
Job Type:Regular
Employee Status:Regular
Travel:Yes, 25% of the time
Job Posting:2011-Jan-11
Description
Essential Job Functions

* Detects Medicare and/or Medicaid claims fraud by applying a wide variety of proactive and reactive strategies. Carries out investigations by focusing on deviant claims patterns and fraud indicators. Works as a team member with other investigators, data analysts, medical professionals, etc to investigate specific cases. Prepares reports for referral to law enforcement. Performs other duties as assigned by the Zone Director that contribute to organiztional goals and mission.
* Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities.
* Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates.
* Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design.
* Assists in developing and modifying systems requirements documentation to meet client needs.
* Participates in meetings with clients to gather and document requirements and explore potential solutions.
* Executes systems test from existing test plans. Assists in analyzing testing results in all phases.
* Participates in technical reviews and inspections to verify 'intent of change' is carried through phases of project.



Qualification

Basic Qualifications

* Bachelor's degree or equivalent combination of education and experience
* Bachelor's degree in business administration, information systems, or related field preferred
* Zero or more years of business analysis experience
* Experience working with the interface of information technology with functional groups within an organization
* Experience working with business processes and re-engineering
* Experience working with computer programming concepts and basic language


Other Qualifications

* Basic interpersonal skills to interact with customers and team members
* Basic communication skills
* Basic analytical and problem solving skills
* Basic presentation skills to communicate with management and customers
* Basic personal computer and business solutions software skill
* Ability to work in a team environment
* Willingness to travel

Remote Work Location Authorized:No
Relocation Assistance:Not Available
Clearance Level:None