The investigator is responsible for administering fraud, waste, and abuse (FWA) duties, including performing investigations and ensuring effective prevention measures. They also prepare audit reports, provide recommendations for corrective actions, and assist in maintaining regulatory compliance.
The Payment Integrity Analyst executes claims investigation and recovery strategies to identify cost containment opportunities and ensure payment accuracy. They collaborate with internal departments and external vendors to audit claims, document root causes of overpayments, and manage provider disputes.
The investigator is responsible for administering fraud, waste, and abuse (FWA) duties to ensure effective prevention, detection, and correction measures. They perform investigations, prepare audit reports, and provide recommendations to ensure compliance with CMS and OHA/OHP requirements.
The Registered Nurse performs telephonic outreach to support HEDIS and Stars measure gap closure while assisting members with clinical needs. They also conduct chart reviews for quality improvement projects and maintain accurate data entry within specialized software.
This position leads data analysis and visualization efforts to meet clinical performance metrics and regulatory deliverables. It also involves mentoring less experienced analysts and providing strategic recommendations to leadership.
The Actuarial Services Manager is responsible for managing actuarial components of financial reporting, including IBNR estimates, trend forecasting, and ROI analysis. The role also involves leading a team, building cross-functional relationships, and providing strategic input for organizational goals.
Translate member materials from English to Spanish, ensuring cultural and linguistic appropriateness for healthcare content. Collaborate with creative teams to deliver high-quality, brand-consistent translations within strict deadlines.
