Attorney in New York City, NY

In-House

New York City, NY

Attorney in New York City, NY

Non-practicing Attorney

Min 5 yrs required

No

Investigator Senior - Payment Integrity
Location: New York

Overview:

The Investigator Senior at **MEMBERS ONLY**SIGN UP NOW***. is responsible for independently identifying, investigating and developing complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. This role is crucial in supporting the Payment Integrity line of business and requires a deep understanding of health insurance policies, claims handling, and provider network contracting. The Ideal candidate must live within 50 miles of one of our New York PulsePoint locations and will work a hybrid model of remote and office work.

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 internally with senior level management and legal department throughout investigative process.
• Assist in training of internal and external entities.
• Develop and maintain rapport and cooperation with federal, state, and local law enforcement and regulatory agencies.
• 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:

• BA/BS and minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement; or any combination of education and experience, which would provide an equivalent background.
• Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred.
• Knowledge of plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

Salary Information:

For candidates working in person or remotely in the below location(s), the salary range for this specific position is $78,400 to $141,120.

• New York

In addition to your salary, **MEMBERS ONLY**SIGN UP NOW***. offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. **MEMBERS ONLY**SIGN UP NOW***. is fully 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.

Who We Are:

**MEMBERS ONLY**SIGN UP NOW***. is a Fortune 25 company dedicated to improving lives and communities through simplified healthcare. We are looking for passionate leaders at all levels of the organization who are committed to making a positive impact on our members and the communities we serve.

Our Culture:

At **MEMBERS ONLY**SIGN UP NOW***., we prioritize creating a culture that fosters personal and professional growth for our associates. Our values and behaviors are the foundation of our culture and drive our shared success - for our consumers, our associates, our communities, and our business.

Benefits and Workforce Strategy:

We offer market-competitive total rewards that include merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, among others.

**MEMBERS ONLY**SIGN UP NOW***. operates in a hybrid workforce strategy, with the expectation that associates will work at an **MEMBERS ONLY**SIGN UP NOW***. location at least once per week. Specific requirements and expectations for onsite work 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.

COVID-19 Vaccination Requirement:

The health of our associates and communities is a top priority for **MEMBERS ONLY**SIGN UP NOW***. As such, we require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. **MEMBERS ONLY**SIGN UP NOW***. will also follow all relevant federal, state, and local laws.

Equal Employment Opportunity:

**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.

Fair Chance Ordinance:

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Conclusion:

**MEMBERS ONLY**SIGN UP NOW***. is seeking a motivated and experienced Investigator Senior to join our team and contribute to our mission of improving lives and communities through simplified healthcare. If you have a passion for making a positive impact and meet the qualifications for this role, we encourage you to apply now.