Financial Investigator Job Listing at Medical Mutual in Rossford, OH (Job ID 2400437)

Description

Note, requires 2 days per week in-office in Rossford, Ohio.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsibilities

Financial Investigator

Participates in the data and fact gathering activities which encompass the vigorous pursuit of criminal fraud and prevent future fraudulent payments. Supports investigative activities (external and internal) of the Company's claims payment operations, providers of service, subscribers, and employees.

·         Analyzes data to compile documentation of fraudulent behaviors.

·         Examines claims information and identifies those with fraudulent billing patterns.

·         Communicates with other departments to ensure consistency with policy and procedures.

·         Performs other duties as assigned.

Senior Financial Investigator

Pursues criminal fraud and prevents future fraudulent payments. Investigates allegations of unlawful activity directed at corporate assets and continually maintains surveillance and investigative activities (external and internal) of the Company's claims payment operations to providers of service, subscribers, and employees.

·         Examines claims information and identifies those with fraudulent billing patterns. Initiates and conducts an investigation via research, medical record audit, reporting etc.

·         Analyzes data to compile documentation of fraudulent behaviors.

·         Analyzes and develops software programs/systems to monitor investigative process.

·         Communicates with other departments to ensure consistency with policy and procedures.

·         Performs other duties as assigned.

Qualifications

Financial Investigator

·         Bachelor's Degree in Criminal Justice, Business Administration or related field or an equivalent combination of education and experience.

·         3 years' experience as a Financial Investigations Specialist or equivalent experience in fraud review in the health insurance industry.

·         Accredited Health Care Fraud Investigator preferred.

·         Health Care Anti-Fraud Associate preferred.

·         Certified Fraud Examiner preferred.

·         Certified Professional Coder preferred.

·         Intermediate Lexis Nexus, VIPS software, DB-2, claims database, and Microsoft Office skills.

·         Ability to perform rudimentary mathematical functions/calculations i.e.: addition, subtraction, percentages, fractions.

·         Knowledge of medical terminology and coding.

Senior Financial Investigator

·         Bachelor's Degree in Criminal Justice, Business Administration or related field or an equivalent combination of education and experience.

·         5 years' experience as a Financial Investigator or equivalent progressive fraud investigation experience in the health insurance industry.

·         Certified Fraud Examiner preferred.

·         Accredited Health Care Fraud Investigator preferred.

·         Certified Professional Coder preferred.

·         Health Care Anti-Fraud Associate preferred.

·         Intermediate to advanced Lexis Nexus, Clear, VIPS software, DB-2, claims database, and Microsoft Office skills.

·         Knowledge of medical terminology and coding.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.