Senior Fraud Investigator

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary: BASIC FUNCTION: HCSC is looking for a dynamic individual to join its Fraud Investigations team! This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally, as well as make recommendations for prosecution, recovery and litigation. Also, reviews operational controls, and claim system controls and protocols, and recommends enhancements to reduce the potential for fraud. Incumbent performs detailed analysis of claim payment data, prepares analysis and evidentiary reports; monitors potentially fraudulent claims and suspect billing patterns along with inquiries and other business matters for HCSC and all its subsidiaries and subcontractors; and be responsible for criminal and civil case development...