Investigator I

HMSA is seeking an Investigator I for their Special Investigations Unit. The role involves managing fraud, waste, and abuse allegations, conducting investigations, and coordinating with various entities to resolve cases.ResponsibilitiesManage FWA case investigations, collaborate with federal, state and law enforcement entities, and provide applicable notifications as requiredMaintain extensive documentation and evidence for SIU casesRecommend and implement preventive measures to combat FWA schemes including, but not limited to provider education, policies, claims edits and payment suspensionsManage the recovery, allocation and documentation of health plan funds resulting from FWA findingsManage the intake, documentation and resolution of FWA referrals to SIUCoordinate with internal and external partners on FWA allegationsAssess needs, make recommendations and complete timely reviews in accordance with all regulatory requirementsCreate and maintain internal policies and procedures, workflows and presentations and present as needed to internal and external entitiesSupport regulatory audits and RFIs from law enforcement and federal and state entitiesRepresent SIU at cross functional workgroups and meetings and present case recommendations to other applicable business areas including, but not limited to Legal, Medical Management, Provider Operations and Claims AdministrationPerform all other miscellaneous responsibilities and duties as assigned or directedSkillsBachelor's degree and one (1) year of related work experience; or equivalent combination of education and related work experienceFundamental knowledge/awareness of Fraud, Waste and AbuseStrong oral and written communication skillsBasic working knowledge of Microsoft Word, Excel, and PowerPointIntermediate working knowledge of Microsoft OutlookCompany OverviewHMSA is an insurance company that provides affordable health plans, employee benefits services and worksite wellness programs. It was founded in 1938, and is headquartered in Honolulu, Hawaii, USA, with a workforce of 1001-5000 employees. Its website is https://www.hmsa.com.



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