Regulatory Compliance Analyst at Three Point Solutions Inc
Baltimore, MD
About the Job
Job Title: Corporate Governance - Analyst, Regulatory Compliance (Hybrid)
Client: Healthcare Insurance Company
Duration: 6 Months
Location: Baltimore, MD 21224
General Information
Job Description:
The Special Investigations Unit (SIU) Investigator's role is to assist in reducing and recuperating losses through detecting, investigating, and resolving low to medium levels of fraud, waste, and abuse schemes, resulting in savings and fund recovery.
Responsibilities:
Independently conduct low to medium-level investigations; support team in more complex cases.
Develop and execute investigative plans, including audits of financial/business records, medical data, claims, and more.
Support offsite audits/investigations and interviews.
Research claims activity, data systems, and medical policies to identify control deficiencies and non-compliance.
Develop documentation, including formal reports, spreadsheets, and audit logs.
Ensure timely, effective audits and investigations aligned with unit goals.
Analyze claims data using anti-fraud software, Excel, and other tools to identify new cases.
Maintain detailed, accurate case file documentation.
Initiate claim adjustments, voucher deducts, and refunds to recover funds.
Perform special projects as assigned by management.
Qualifications:
Education Level: Bachelor's Degree
Experience: 2 years in insurance, investigation, healthcare, nursing, or law enforcement
(In lieu of a degree, 4 additional years of relevant experience required.)
Preferred Qualifications: Credential in healthcare or investigations (e.g., CFE, AHFI, RN/LPN, CPC).
Knowledge of ICD 10 and CPT Codes, medical terminology, claims, customer service methods, and prior healthcare industry experience.
Knowledge, Skills, and Abilities (KSAs):
Knowledge of laws related to public/insurance funds - Proficient
Excellent written and verbal communication skills - Proficient
Problem recognition, analysis, and resolution - Proficient
Effective interpersonal relationships - Proficient
#ZR
Client: Healthcare Insurance Company
Duration: 6 Months
Location: Baltimore, MD 21224
General Information
Job Description:
The Special Investigations Unit (SIU) Investigator's role is to assist in reducing and recuperating losses through detecting, investigating, and resolving low to medium levels of fraud, waste, and abuse schemes, resulting in savings and fund recovery.
Responsibilities:
Independently conduct low to medium-level investigations; support team in more complex cases.
Develop and execute investigative plans, including audits of financial/business records, medical data, claims, and more.
Support offsite audits/investigations and interviews.
Research claims activity, data systems, and medical policies to identify control deficiencies and non-compliance.
Develop documentation, including formal reports, spreadsheets, and audit logs.
Ensure timely, effective audits and investigations aligned with unit goals.
Analyze claims data using anti-fraud software, Excel, and other tools to identify new cases.
Maintain detailed, accurate case file documentation.
Initiate claim adjustments, voucher deducts, and refunds to recover funds.
Perform special projects as assigned by management.
Qualifications:
Education Level: Bachelor's Degree
Experience: 2 years in insurance, investigation, healthcare, nursing, or law enforcement
(In lieu of a degree, 4 additional years of relevant experience required.)
Preferred Qualifications: Credential in healthcare or investigations (e.g., CFE, AHFI, RN/LPN, CPC).
Knowledge of ICD 10 and CPT Codes, medical terminology, claims, customer service methods, and prior healthcare industry experience.
Knowledge, Skills, and Abilities (KSAs):
Knowledge of laws related to public/insurance funds - Proficient
Excellent written and verbal communication skills - Proficient
Problem recognition, analysis, and resolution - Proficient
Effective interpersonal relationships - Proficient
#ZR
