Attorney in Lake Success, NY

In-House

Lake Success, NY

Attorney in Lake Success, NY

Non-practicing Attorney

Min 5 yrs required

No

Investigator Senior – Join a Leading Healthcare Company in New York!

Department: Payment Integrity

Location: New York (hybrid model - remote and office)

Salary Range: $78,400 to $141,120

**MEMBERS ONLY**SIGN UP NOW***., a member of the **MEMBERS ONLY**SIGN UP NOW***. family of companies, is seeking a highly skilled and experienced Investigator Senior to join our Payment Integrity team. In this role, you will be responsible for identifying, investigating, and developing complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds. We are looking for someone with a strong background in health insurance and healthcare insurance investigation, with a deep understanding of health insurance policies, claims handling, and provider network contracting.

Why join **MEMBERS ONLY**SIGN UP NOW***.?

- **MEMBERS ONLY**SIGN UP NOW***. is a Fortune 25 company with a longstanding history in the healthcare industry, dedicated to improving lives and communities.
- We offer a range of market-competitive total rewards and benefits, including medical, dental, vision, 401(k) + match, stock purchase plan, and more.
- We are committed to ensuring equal pay opportunities for equal work, regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
- We are creating a culture designed to advance our strategy and drive personal and professional growth for our associates.

Responsibilities:

- Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional, and pharmacy claims.
- Independently identify and develop enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business, and/or state.
- Interface with senior-level management and legal department throughout the investigative process.
- Assist in training internal and external entities.
- Develop and maintain relationships with federal, state, and local law enforcement and regulatory agencies to assist in investigative efforts.
- Assist in the development of policies and procedures to prevent loss of company assets.
- May be called upon to represent the company in court proceedings regarding research findings.

Requirements:

- Bachelor's degree in a related field and a minimum of 5 years of experience in healthcare insurance and healthcare insurance investigation, law enforcement, or a combination of education and experience.
- Professional certification such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designation preferred.
- Knowledge of health insurance policies and procedures, with a heavy emphasis on negotiation.
- Health insurance experience required, with a deep understanding of health insurance policies, claims handling, and provider network contracting.

Benefits & Compensation:

- Competitive salary range of $78,400 to $141,120.
- Comprehensive benefits package, including medical, dental, vision, 401(k) + match, stock purchase plan, and more.
- Equal pay opportunities for equal work, regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

**MEMBERS ONLY**SIGN UP NOW***. operates in a Hybrid Workforce Strategy, with associates required to work at an **MEMBERS ONLY**SIGN UP NOW***. location at least once per week. Specific requirements and expectations for time onsite will be discussed during the hiring process. Candidates must reside within 50 miles or a 1-hour commute each way of a relevant **MEMBERS ONLY**SIGN UP NOW***. location.

At **MEMBERS ONLY**SIGN UP NOW***., the health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. Accommodations may be made for medical or religious reasons.

**MEMBERS ONLY**SIGN UP NOW***. is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact **** for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Join our team at **MEMBERS ONLY**SIGN UP NOW***. and make a difference in the lives of our members and the communities we serve! Apply now.