Investigator Assistant
About The Position
The Investigator Assistant provides administrative support to the pharmacy investigative unit and researches data to help identify potential overpayments or abuse. The role is hybrid, requiring associates to work in-office one to two days per week. Candidates must live within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. Alternate locations may be considered for candidates within commuting distance of an office. The schedule is Monday through Friday, with flexible start and end times within a daily eight-hour shift; the stated work window is 7:00 a.m. to 5:00 p.m. The position requires a high school diploma or equivalent and at least one year of experience in healthcare, retail pharmacy, and/or Medicaid, or an equivalent combination of education and experience.
Requirements
- High school diploma or equivalent.
- At least one year of experience in healthcare, retail pharmacy, and/or Medicaid, or an equivalent combination of education and experience.
Nice To Haves
- One or more years of experience using MS Excel with large data files and other general reporting tools.
- Experience in health insurance or law enforcement.
- Pharmacy technician license and/or pharmacy experience.
- Experience with formulary, clinical rules, pharmacy claims analysis, and/or prior authorization for a pharmacy benefit manager or health plan.
- Ability to communicate information clearly and concisely, orally and in writing, in a professional and legal environment.
Responsibilities
- Collect, research, and validate bills and claims data against relevant guidelines.
- Assist with preparing statistical and financial analysis reports.
- Respond to requests for information from state agencies and law enforcement.
- Request medical records and other documentation needed for investigations.
- Complete initial file setup and track cases.
- Work with vendors to provide case status and updates.
- Process and track incoming reimbursement checks.
- Assist in managing fraud hotline calls.
- Provide administrative support to investigative management and staff.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid time off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
