Job Description
Job Description
Lyra seeks a highly skilled and experienced contractor to play a pivotal role in supporting our
Fraud, Waste & Abuse (FWA) and complaint handling processes. The successful candidate will be adept at navigating complex situations, possess a nuanced
understanding of Lyra's policies and procedures, and demonstrate exceptional communication and interpersonal skills.
Key Responsibilities:
Investigation and Resolution of FWA and Complaints: Conduct thorough and timely
investigations into allegations of fraud, waste, and abuse, as well as other complaints.
This will involve gathering and analyzing evidence, interviewing relevant parties, and
making informed recommendations for resolution.
Policy Interpretation and Application: Demonstrate a comprehensive understanding
of Lyra's policies and procedures, and apply them judiciously to complex and nuanced
situations. This is a 30hr work work role.
Cross-Functional Collaboration: Serve as a liaison and subject matter expert for
cross-functional teams, including Legal, Compliance, Clinical Operations, and Provider
Relations.
Documentation and Reporting: Maintain meticulous records of investigations,
communications, and case outcomes. Prepare clear and concise reports for internal
stakeholders and regulatory bodies as needed.
Process Improvement: Identify opportunities to enhance the efficiency and
effectiveness of FWA and complaint handling processes. Contribute to the development
and implementation of best practices.
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form ( . The EEOC "Know Your Rights" Poster is available here ( .
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: .
Skills and Requirements
Responsibilities
Handle performance-related complaints about providers, conduct outreach to
gather insights, and collaborate with internal teams to take corrective actions.
Support with Fraud, Waste & Abuse (FWA) investigations, outreach, coordination
and dashboard reviews.
Provide recommendations and support for initiatives to continuously refine and
improve our data review processes to maximize effectiveness.
Collaborate with cross-functional teams to ensure alignment on outreach
approach and timing.
Qualifications
3-5 years combined relevant work experience.
Previous experience with Fraud, Waste & Abuse (FWA) investigations.
Bachelors degree in Healthcare Administration, Business Administration or
Communications, a plus.
Ability to work independently, multi-task and maintain strong attention to detail.
Proficiency in using Tableau, or a similar platform, to analyze data and translate it
into actionable insights.
Experience with CRM systems (e.g., Salesforce) and ticketing platforms (e.g.,
Zendesk) a plus.
Excellent written and verbal communication skills, with experience conducting
outreach. null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.
Job Tags
For contractors, Work experience placement,
Similar Jobs
The Alta Group
...Controller - Automotive Want to go beyond the numbers, have a seat at the table and make an impact? Our client is an auto industry... ...Controller will be the financial business partner to general management, will lead accounting and finance staff, own the P&L for a large...
Career Consulting Partners
...Pre-litigation Attorney Career Consulting Partners is collaborating with a successful injury law firm that offers legal representation... ...professional development resources ~ Enjoy the benefits of remote work with our advanced, fully paperless system, designed to...
Jianghu education
...Classin for online teaching, lessons will be scheduled in advance in Classin Required LanguagesEnglish, French, German, Spanish, Japanese Hello teachers,We are an online language tutoring platform based in Guangzhou, China. Now looking for online native German,...
GQR
June or July Start Date GQR GLOBAL MARKETS Healthcare Recruiter - Permanent Nursing Division New York, NY - Hybrid (In office Tuesday-Thursday), 8am-6pm schedule Office location - 408 W 14th St The Opportunity: This is a 180 recruitment role , meaning...
Blue Lake Capital
We are a rising real estate company. We are young, nimble, and love to work with passion and energy! Our goal is to become a $1B company and we are hiring team players to help us to continue getting there. We are looking for a technically savvy, well-organized, and highly...