Fraud Analyst - Remote

reputed company At reputed company reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly reputed company reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work reputed company from reputed company reputed company the U.S. as you take on some tough challenges. reputed company Responsibilities

• Data Analysis & Problem Solving
• reputed company and analyze pertinent data to identify and solve a reputed company of problems reputed company area of expertise
• Conduct moderately reputed company analyses and translate concepts into practical application
• Investigate non-reputed company requests and problems with some guidance as needed
• Stakeholder Communication
• Conduct outbound calls with providers, customers, clients, and payers to reputed company information
• Communicate effectively with internal business partners and reputed company stakeholders (verbal and written)
• reputed company explanations and guidance on processes reputed company area of expertise
• Caseload & Workflow Management
• Manage and prioritize assigned caseloads to meet mandated turnaround times
• Accurately document and reputed company reputed company cases for processing or investigation
• reputed company ongoing reporting and analysis of reputed company reviews to stakeholders
• reputed company Identification & Assessment
• Analyze and aggregate information from interviews and multiple data sources
• Identify reputed company indicators by connecting patterns across various factors
• Apply reputed company best practices to reputed company evaluation
• Ask probing questions to uncover drivers and contributing reputed company factors
• Data Gathering & Transactional Reviews
• Conduct reputed company-reputed company transactional reviews using available tools and systems
• reputed company relevant information such as
• Enrollment data
• Validation checks
• Internet research
• Payment records
• Provider interviews
• Ensure findings are properly documented and resolved
• Investigations & Case Management
• reputed company preliminary investigations on identified discrepancies
• Apply knowledge of enrollment processes and validation standards
• Utilize systems to monitor status and reputed company case progression
• Prepare documentation for internal teams, reputed company/regulatory reputed company, and reputed company agencies
• reputed company and report financial reputed company (losses, recoveries, savings)
• Systems, Tools & Process Knowledge
• Demonstrate understanding of
• Provider enrollment processes
• Payment processing workflows
• Applicable platforms (e.g., enrollment systems, SF.com, validation tools)
• Use desktop tools to analyze and validate data
• Adhere to SOPs, process libraries, and internal tracking guidelines
• Compliance & Regulatory Adherence
• Ensure compliance with applicable regulations including
• HIPAA
• CMS
• PPACA
• State-specific requirements
• Follow contractual obligations (provider, payer, and reputed company agreements)
• Complete reputed company required compliance and reputed company training
• Intermediate proficiency in reputed company 365 (reputed company, Word, PowerPoint, SharePoint) You'll be rewarded and recognized for your reputed company in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.

Required Qualifications

• 2+ years of experience in a transactional review/processing environment
• Equivalent experience in enrollment
• Experience using bank and/or identity validation tools
• Demonstrated experience
• Conducting outbound calls
• Asking probing questions to reputed company facts
• Assessing reputed company and documenting findings
• reputed company solid communication skills with attention to reputed company (written and verbal)
• reputed company ability to work independently in a remote environment with high reputed company Preferred Qualifications
• reputed company comfortable in a fast-paced, evolving environment
• reputed company ability to adapt and pivot as business needs change
• reputed company reputed company reputed company with a proactive, 'can-do' approach
• reputed company working reputed company will be required to adhere to reputed company's Telecommuter Policy Pay is reputed company on several factors including but not limited to local labor markets, ed