Investigator II - Fraud Operations

Point32Health • Canton, MA

12d • $80,098 - $120,147

About The Position

Point32Health is currently seeking highly motivated individuals to join our organization as a Fraud Operations Specialist within our Special Investigations Unit (“SIU”). The Fraud Operations Specialist is an essential team member of the SIU, responsible for developing and maintaining relationships with business units, vendors, law enforcement agencies, regulators and other parties with direct interaction with the SIU. The Sr. Fraud Operations specialist will also create and deliver anti-fraud training to internal business units.

Responsibilities

• Developing a deep understanding of overall plan operations to assist SIU investigative staff in obtaining information.
• Creation and delivery of annual anti-fraud training as well as tailored presentations delivered to various business units.
• Oversees the preparation and submission of SIU Independent Review Organization submissions.
• Serves as point-person for SIU regulatory and contractual audit preparation and response.
• Maintain SIU contractual and regulatory compliance including serving as the point person for SIU mandatory reporting.
• Performs annual and periodic maintenance of the SIU Policies & Procedures manual
• Represents the SIU on various internal working groups, and committees.
• Responsible for leading complex provider investigations related to fraud, waste and abuse, and developing action plans to address the investigative findings and prevent future loss.
• Perform out-of-the-box thinking, collaborate with others, and make a difference every day!
• Maintains a small investigative caseload.
• Collaborates with Point32Health Legal department and SIU Data Analytics team to provide data and documents in response to law enforcement subpoenas and requests for information.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees