Healthcare Fraud Investigator - Home Based Phoenix (1058-852)

Delmarva Foundation Phoenix , AZ 85002

Posted 2 weeks ago

Qlarant

Best People. Best Solutions. Best Results.

Qlarant, Inc., is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.

Are you an experienced Healthcare Fraud Investigator with a track record of successful outcomes and exceeding expectations? As a Health Care Fraud Investigator working on our Unified Program Integrity Contractors (UPIC) team for the Western Jurisdiction, you can contribute to our efforts to make a positive difference in the future of the Medicare and Medicaid programs. Our UPIC West team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 13 states and 3 territories.

Please Note: This is a home-based position with preference given to candidates in the Phoenix area. Candidates outside the UPIC Western jurisdiction will not be considered.

Our investigators independently perform in-depth evaluation and make field level judgments related to investigations of potential Medicare and Medicaid fraud, waste and abuse investigations or cases that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action.

Essential Duties and Responsibilities include the following. Other duties may be assigned

  • Utilizes leads provided by the team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination.

  • Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.

  • Based on contract requirements, may refer potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee.

  • Conducts interviews of witnesses, informants, and subject area experts and targets of investigations.

  • Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, may provide information to support the preparation of attestations/referrals or supervising the preparation of attestations/referrals as needed.

  • Drafts investigation reports, evaluates investigation reports, and promotes effective and efficient investigations.

  • Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.

  • Testifies at various legal proceedings as necessary.

  • Identifies opportunities to improve processes and procedures.

  • Has the responsibility and authority to perform their job and provide customer satisfaction.

Required Skills

  • Ability to work independently with minimal supervision.

  • Ability to communicate effectively with all members of the team to which he/she is assigned.

  • Ability to grasp and adapt to changes in procedure and process.

  • Ability to effectively resolve complex issues.

  • Ability to mentor other associates.

Required Experience

  • A Bachelor's Degree or one or more of the following:

  • certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification

  • successful completion of a law enforcement academy

  • experience in health care fraud investigation/detection.

  • Must possess experience in a federal or state healthcare programs or a closely related field.

  • Prior successful experience with CMS and OIG/FBI or similar agencies preferred.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Phoenix Healthcare Account Manager

Nutanix

Posted 2 weeks ago

VIEW JOBS 3/7/2019 12:00:00 AM 2019-06-05T00:00 Nutanix is a cloud computing software company that sells hyper-converged infrastructure appliances and software-defined storage. We were founded in 2009 and have been a publicly held company since 2016. We were named 2018 Gartner Magic Quadrant for Hyper-Converged Systems leader. Nutanix is the right fit for you if you are passionate about technology, creative, and accomplished in your growing career. We pride ourselves on our encouraging culture where you learn from failures, pick yourself back up and become the best version of yourself. Nutanix offers several opportunities to participate in professional development and learning, fostering an inspiring environment. We believe in not only supporting you, but also your families through fully-paid healthcare plans, equity, and other financial tools and wellness programs. HealthCare Account Manager Nutanix is looking for a Healthcare Account Manager in Phoenix. As Healthcare Account Manager, you are responsible for selling Nutanix's Products and Solutions through Channel Partners and interacting directly with customers in the region. You will also be working closely with a Sales Engineer in the territory. Essential to success in this role is a keen ability develop new accounts and to penetrate new divisions and organizations within your assigned accounts. Nutanix provides extraordinary support and tools from the Engineering, Marketing, and Product Development departments for you to leverage to exceed sales performance goals. In this position you would be working very closely the co-founders and VPs and have a large amount of influence on sales team decisions and initiatives. Responsibilities * Use relationship management techniques to develop selling opportunities within partner organizations; penetrate new divisions and organizations within assigned partner account; develop new selling relationships within assigned partner account; develop new direct selling opportunities. * Schedule and attend sales call appointments with a prospect in partner organization. Nutanix Channel Partner Representatives may also participate in the sales call to help qualify the opportunity. * Utilizing a consultative approach, discuss business issues with prospect and develop a formal quote, a written sales proposal or a formal sales presentation addressing their business needs. * Respond to RFP's and follow up with prospects. * Develop an account plan to sell to customers based on their business needs. * Build and strengthen the business relationship with current accounts and new prospects. * Recommend marketing strategies. * Provide status information to your Manager including forecast/pipeline information. * Provide, or facilitate training opportunities for your accounts. * Identify Nutanix customer references that can be utilized when reference selling. * Provide product feedback back to engineering to improve Nutanix complete block solutions Skills * Strong verbal and written communications skills including presentation skills. * Ability to work collaboratively with employees within the sales function and across functions including Marketing, Sales Operations, System Engineering, and Product Development. * Experience with target account selling, solution selling, and/or consultative sales techniques * An aptitude for understanding how technology products and solutions solve business problems as well as the competitive landscape. * Ability to communicate with senior managers about their business challenges and Nutanix data management storage solutions. * Experience using SFDC and other CRM software. * Track record of exceeding assigned sales quotas in contiguous, multiple years. Qualifications and Experience * 5 to 10 years of sales experience preferred. * Experience selling into the healthcare vertical * Experience that demonstrates a strong level of expertise in technical specifications required to sell Nutanix products and services is required. * Bachelor's Degree or equivalent experience Nutanix Phoenix AZ

Healthcare Fraud Investigator - Home Based Phoenix (1058-852)

Delmarva Foundation