Collins Consulting
Fraud Detection_Fraud Executive Advisor
Collins Consulting, Myrtle Point, Oregon, United States, 97458
This is a remote position and a part‑time position (15 hours per month). Must be a US Citizen or Permanent Resident.
Statement of Work The client is delivering a NexGen Program Integrity Solution where we will be using the client tool, FAMS (Fraud and Abuse Management System), to perform fraud detection on Defense Health Agency (DHA) active duty medical claims for both pre-payment, known as in-line fraud detection, and post-payment, known as retrospective fraud detection. We will also be integrating this fraud detection tool with the ATOM platform, to provide a case management solution that enables fraud analysists to disposition alerts and conduct investigations on flagged claims as required.
Task Description The TriWest Fraud Detection services Fraud Executive Advisor will support the Fraud and Abuse Management System (FAMS) Team as they deploy FAMS to detection fraud on claims within the T5 contract.
Required skills / Level of Experience
Experience leading Fraud and Abuse Management System (FAMS) Tool implementations
Experience working on the TriWest T5 Fraud Detection Services Contract
Experience and relationships with TriWest C‑Suite leadership
Experience with Defense Health Agency fraud detection and VA Community Care Network (CCN) fraud detection
Experience with healthcare fraud detection
20+ years of experience in FWA detection
Nice to have skills
Familiarity with Appian
Experience with Public Sector Clients (US Federal, Higher Education, State and Local Governments)
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Statement of Work The client is delivering a NexGen Program Integrity Solution where we will be using the client tool, FAMS (Fraud and Abuse Management System), to perform fraud detection on Defense Health Agency (DHA) active duty medical claims for both pre-payment, known as in-line fraud detection, and post-payment, known as retrospective fraud detection. We will also be integrating this fraud detection tool with the ATOM platform, to provide a case management solution that enables fraud analysists to disposition alerts and conduct investigations on flagged claims as required.
Task Description The TriWest Fraud Detection services Fraud Executive Advisor will support the Fraud and Abuse Management System (FAMS) Team as they deploy FAMS to detection fraud on claims within the T5 contract.
Required skills / Level of Experience
Experience leading Fraud and Abuse Management System (FAMS) Tool implementations
Experience working on the TriWest T5 Fraud Detection Services Contract
Experience and relationships with TriWest C‑Suite leadership
Experience with Defense Health Agency fraud detection and VA Community Care Network (CCN) fraud detection
Experience with healthcare fraud detection
20+ years of experience in FWA detection
Nice to have skills
Familiarity with Appian
Experience with Public Sector Clients (US Federal, Higher Education, State and Local Governments)
#J-18808-Ljbffr