What are the responsibilities and job description for the Special Investigator position at Amerihealth Caritas?
A critical role awaits: Investigator.
About the Position
We seek passionate individuals to join our team in preventing fraud, waste, and abuse across the AmeriHealth Caritas Family of Companies (ACFC).
Key Responsibilities:
- Lead investigations into potential fraud, ensuring accuracy, efficiency, and compliance with legal and regulatory standards.
- Conduct in-depth interviews, gathering evidence according to criminal and civil legal guidelines.
- Analyze claims, billing data, and emerging patterns to detect fraudulent activity.
- Develop comprehensive investigative reports, clearly interpreting findings.
- Represent ACFC in discussions with providers, law enforcement, and regulatory bodies.
Requirements
- Associate's degree required (Bachelor's preferred).
- Minimum 3-5 years of experience conducting healthcare fraud investigations.
- Strong knowledge of Medicaid, Medicare, and fraud-related regulatory statutes.
- Proficiency in Microsoft Excel and clear communication of findings.
About Us
AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering comprehensive care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management, and specialty pharmacy services.
