Fraud Investigator

7 days ago

Schenectady, New York, United States MVP Health Care, Inc. Full time
About the Role

We are seeking a highly skilled Fraud Investigator to join our team at MVP Health Care, Inc. As a key member of our organization, you will play a critical role in identifying and investigating fraudulent activities, ensuring compliance with regulatory requirements, and promoting a culture of integrity within our company.

Key Responsibilities
  • Investigations and Reporting: Conduct thorough investigations into suspected fraudulent activities, gathering and analyzing evidence, and preparing detailed reports to support findings and recommendations.
  • Compliance and Risk Management: Stay up-to-date with federal and state anti-fraud requirements, including HIPAA, CMS, Medicare, and Medicaid, and ensure compliance with corporate policies and procedures.
  • Collaboration and Communication: Work closely with internal stakeholders, including law enforcement agencies, regulatory bodies, and external partners to share information, coordinate efforts, and resolve issues.
  • Training and Education: Develop and deliver training programs to educate employees on compliance and risk management best practices, and provide guidance on regulatory requirements.
  • Testimony and Representation: Represent the company in legal proceedings, providing expert testimony and supporting the defense of our organization.
Requirements
  • Education and Experience: An Associate's or Bachelor's degree in a related field, such as Criminal Justice, or equivalent combination of education and experience.
  • Investigations and Compliance Experience: A minimum of 5 years of experience in insurance claims investigation or professional investigation with law enforcement agencies.
  • Skills and Qualifications: Superior judgment skills, excellent verbal and written communication skills, and the ability to work in a fast-paced environment.
What We Offer
  • Competitive Compensation and Benefits: A comprehensive benefits package, including competitive salary, health insurance, and retirement plans.
  • Opportunities for Growth and Development: A supportive and collaborative work environment, with opportunities for professional growth and development.
  • Recognition and Rewards: Recognition and rewards for outstanding performance and contributions to the company's success.
Work Environment

This role is based in Schenectady, NY, with the option to work from home two days a week. We are committed to providing a safe and inclusive work environment, and we welcome applications from diverse candidates.

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