Legal Staff Paralegal in Seattle, WA

In-House

Seattle, WA

Legal Staff Paralegal in Seattle, WA

Legal Staff

Min 5 yrs required

No

Summary:

The position of Investigator Senior at **MEMBERS ONLY**SIGN UP NOW***. is responsible for identifying, investigating, and developing complex cases of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. This role requires a strong understanding of health insurance policies, claims handling, and provider network contracting. The ideal candidate must have at least 5 years of related experience in healthcare insurance and healthcare insurance investigation, law enforcement, or a combination of education and experience. A professional certification in a relevant field is preferred.

Locations and Salary:

- This position is available in various locations, including California, Colorado, District of Columbia, Maryland, Minnesota, Nevada, New York, and Washington State.
- The salary range for this role is $77,028 to $132,048, based on geographic location, work experience, education, and skill level. Other benefits, such as a comprehensive benefits package, equity stock purchase, and 401k contribution, are also available.

Responsibilities:

- Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems.
- 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.
- Train internal and external entities as needed.
- 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 represent the company in court proceedings regarding research findings.

Qualifications:

- Bachelor's degree in a related field and at least 5 years of experience in healthcare insurance and healthcare insurance investigation, law enforcement, or a combination of education and experience.
- Professional certification in a relevant field is preferred.
- Knowledge of plan policies and procedures in all facets of benefit programs management with a heavy emphasis on negotiation is preferred.

Culture and Benefits:

- **MEMBERS ONLY**SIGN UP NOW***. is committed to creating a culture that promotes personal and professional growth for its associates.
- The company offers a range of market-competitive total rewards, including merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short and long-term disability benefits, 401k with match, stock purchase plan, life insurance, wellness programs, and financial education resources.
- **MEMBERS ONLY**SIGN UP NOW***. operates on a hybrid workforce strategy, with associates required to work at least once a week at an **MEMBERS ONLY**SIGN UP NOW***. location, unless specified as primarily virtual by the hiring manager.
- The health of associates and communities is a top priority for **MEMBERS ONLY**SIGN UP NOW***., and all new candidates in certain patient/member-facing roles are required to become vaccinated against COVID-19 and Influenza.

**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, 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. The company also considers qualified applicants with arrest or conviction records in accordance with all federal, state, and local laws.