Fraud Investigator Job at Insight Global, San Jose, CA

d1ZwZjJEZXRKbk5qZGxTdWtBVkp6SEtJL3c9PQ==
  • Insight Global
  • San Jose, CA

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

In House Jobs | JDHuntr

In House Counsel Jobs New York | JDHuntr 60075 Senior Corporate Counsel $145K - $182K (Remote Anywhere USA) Job at In House Jobs | JDHuntr

In House Counsel Jobs New York | JDHuntr 60075 Senior Corporate Counsel $145K - $182K (Remote Anywhere USA) Apply on JDHuntr.com Post Date: 8.24.2023 *Execute on a variety of general corporate legal matters in a fast-paced, high-volume setting to include contract drafting...

Centene Corporation

Health Coach - Wellness Job at Centene Corporation

 ...everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified,...  ...risk and readiness to change+ Provides telephonic support and coaching for members on ongoing wellness care plans and wellness programs... 

Alchemy Global Talent Solutions

Moving Dispatcher Job at Alchemy Global Talent Solutions

 ...Moving Dispatcher New York, NY Join a dynamic and fast-paced moving company in the heart of New York as a Moving Dispatcher. This key logistics role ensures smooth coordination between moving crews, clients, and operations, keeping every relocation on track and up... 

VDart Inc

Scrum Master Job at VDart Inc

 ...Job Title: Scrum Master Location: Remote Duration/Term: Long Term Contract Job Summary: We are seeking an...  ...Framework (SAFe) or other enterprise Agile methodologies . ~ Certified Scrum Master (CSM), SAFe Scrum Master (SSM), or equivalent... 

Timescale

Remote SEO Marketing Manager Job at Timescale

 ...Were scaling rapidly, and to keep up with our growth, were looking for an SEO Marketing Manager to own and execute our search engine optimization strategy, helping Timescale become the go-to resource for developers seeking solutions for time-series data. The ideal...