Claims Investigation Analyst
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Job Location:
Los Angeles, CA - USA
Monthly Salary:
$ 82074 - 114903
Posted on:
9 hours ago
Vacancies:
1 Vacancy
Job Summary
Claims Investigation Analyst
At WelbeHealth we serve our communities most vulnerable seniors through shared intention pioneering spirit and the courage to love. These core values and our participant-focus lead the way no matter what.
The Claims Investigation Analyst plays a crucial and multifaceted role within the organization serving as a key component in the comprehensive effort to meticulously examine and identify potentially fraudulent activities related to claims billing processing and payment. This role involves conducting in-depth investigations that require a keen eye for detail as well as analyzing complex and often intricate data patterns to uncover inconsistencies or anomalies that may indicate fraudulent behavior. The Claims Investigation Analyst actively works to verify the legitimacy of claims by cross-referencing data validating supporting information and utilizing specialized tools and techniques.
This role is different because the Claims Investigation Analyst at WelbeHealth:
Investigates claims in a setting that serves frail seniors meaning your work has a real immediate impact on care delivery access and continuity not just financial reports like in traditional claims roles
Focuses on both detecting issues and strengthening processes making you a proactive partner in improving care delivery rather than a reactive auditor
We care about our team members. Thats why we offer:
Medical insurance coverage (Medical Dental Vision)
Work/life balance - We mean it! 17 days of personal time off (PTO) 12 holidays observed annually and 6 sick days
401K savings match
Comprehensive compensation package including base pay and bonus
And additional benefits!
On the day-to-day you will:
Analyze incidents of suspected fraud waste and abuse in accordance with regulatory requirements and organization policies
Conduct investigations to proactively prevent detect and correct suspected and identified issues of fraud waste and abuse by utilizing a variety of sources including data analytics to detect unusual billing
Thoroughly review all claim documentation including supporting records and correspondence to ensure the integrity of the claims process and maintain strict compliance with regulatory standards and organizational policies
Collaborate with internal stakeholders on findings reporting and remediation
Educate external providers on proper billing practices
Job requirements include:
High school diploma required bachelors degree in relevant field preferred
Minimum of four (4) years of relevant professional experience in a healthcare environment with an emphasis on fraud waste and abuse reviews/investigations or claims pertaining to fraud waste and abuse
Strong knowledge of PACE managed care and Medi-Cal and Medicare programs
Knowledge of federal and state guidelines as well as ICD CPT HCPCS coding
We are seeking Claims Investigation Analysts that ideally have experience working in a PACE/healthcare environment. If youre ready to join a team that values both its participants and team members wed love to hear from you!
Salary/Wage base range for this role is $82074 - $108337 / year Bonus. WelbeHealth offers competitive total rewards package that includes 401k match healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
Compensation
$82074.03 - $114903.64 USD
COVID-19 Vaccination Policy
At WelbeHealth our mission is to unlock the full potential of our vulnerable this spirit please note that we have a vaccination policy for all our employees and proof of vaccination or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity Equity and Inclusion
At WelbeHealth we embrace and cherish the diversity of our team members and were committed to building a culture of inclusion and belonging. Were proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race color religion sex gender gender identity gender expression sexual orientation marital or veteran status age national origin ancestry citizenship physical or mental disability medical condition genetic information or characteristics (or those of a family member) pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @ email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to
Required Experience:
IC
Key Skills
- Food Safety
- Suspicious Activity
- Financial Crimes
- Administrative Hearings
- Ofac
- SAR
- Public Safety
- Law Enforcement
- Due Diligence
- AML
- Criminal History
- escalate
- Procedures
- Subpoenas
About Company
WelbeHealth’s all-inclusive senior health care PACE program is designed to meet the needs of seniors who want to live independently at home.
