Aetna Insurance Careers – SIU Investigator

Job Description:

The SIU Investigator will conduct investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.

Job Responsibilities:

• He/She will conduct investigations of known or suspected acts of healthcare fraud and abuse, communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases.
• This person investigates to prevent payment of fraudulent claims committed by insured’s, providers, claimants, customer members, etc. and facilitates the recovery of company and customer money lost as a result of fraud matters.
• This person provides input regarding controls for monitoring fraud related issues within the business units, delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company.
• Maintains open communication with constituents within and external to the company, uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
• Will research and prepare cases for clinical and legal review, documents all appropriate case activity in tracking system, makes referrals, both internal and external, in the required timeframe, cost effectively manages use of outside resources and vendors to perform activities necessary for investigation.

Job Requirements:

• Strong verbal and written communication skills. Strong customer service skills.
• Ability to interact with different groups of people at different levels and provide assistance on a timely basis.
• Strong analytical and research skills.
• Proficient in researching information and identifying information resources.
• Knowledge of Aetna’s policies and procedures is an asset
• College degree in Criminal Justice or a related field
• Proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
• Ability to utilize company systems to obtain relevant electronic documentation.

Job Details:

Company: Aetna

Vacancy Type: Full Time

Job Location: Louisville, KY, US

Application Deadline: N/A

Apply Here

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