FastTek Global
Special Investigative Unit Investigator #1044197
FastTek Global, Troy, Michigan, United States, 48083
Troy, Michigan
Special Investigative Unit Investigator #1044197
Duties
Investigate reports of non‑compliance with corporate and regulatory policies, including fraud, waste, or abuse.
Recommend methodologies to prevent improper conduct by identifying, assessing, and correcting non‑compliance in risk areas.
Utilize monitoring systems and data‑mining tools to track, remediate, and produce reports.
Handle all assigned investigations, follow‑ups, and resolutions.
Maintain judgement and discretion for sensitive or high‑profile cases, with intellectual rigor for complex, national‑scope fraud schemes.
Principal Duties and Responsibilities
Analyze public and internal data to determine if a full investigation is warranted and develop investigative strategy.
Collect evidence and documentation for adjudication.
Conduct on‑site audits of provider records to ensure billing appropriateness.
Interview providers, employees, members, and witnesses.
Prepare complex investigative and audit reports, presenting metrics, trends, and schemes to stakeholders, including enforcement agencies.
Craft well‑organized referrals explaining alleged fraud to regulators.
Coordinate investigations with law enforcement and regulatory agencies.
Understand organizational strategy and its linkages to related areas.
Make independent decisions about investigative methods with minimal direction.
Follow established guidelines and procedures.
Ensure compliance program meets OIG effective compliance program elements.
Manage a caseload of investigations, identifying schemes, tracking trends, and reporting non‑compliance.
Respond to alleged violations, evaluating or recommending investigative procedures.
Progress investigations from opening to final disposition with minimal assistance.
Develop new cases based on proactive data mining.
Respond to complaints, take statements, and document potential fraud, waste, or abuse.
Identify patterns and trends to generate new investigative leads.
Demonstrate teamwork and collaboration with other investigators.
Show adaptability in taking on varied investigative responsibilities.
Demonstrate experience with Medicare, Medicaid, ACA, and commercial managed care products.
Develop and facilitate training on Fraud, Waste, Abuse, HFH Non‑retaliation policy, Code of Conduct, and government program requirements.
Perform related duties as assigned.
Skills
Experience with RATSTATS or similar sampling programs.
Proficient in Excel for large data analysis, visualization, and automation (macros, pivot tables, Power Query).
Experience with Microsoft Power BI; knowledge of SQL preferred.
Excellent verbal, written, and presentation skills.
Ability to work with diverse backgrounds at all levels.
Objective, creative analytical and auditing skills.
Knowledge of health‑care industry product lines and payment methodologies.
Experience with FACETs or similar claim systems.
Strong personal and professional ethics.
Customer Service Responsibilities
Communication
Understanding
Sensitivity
Teamwork
Personal Qualities
Self‑directed
Flexible and committed to the team concept
Initiative and willingness to learn
Open to new learning experiences
Respectful of diversity without judgment
Demonstrated customer service values
Physical Demands / Working Conditions
Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
Sedentary work; occasional lifting of up to 10 lbs of force.
Requires sitting most of the time; occasional walking or standing.
Verbal communication required.
Hearing required.
Benefits
Medical and Dental (majority paid by FastTek)
Vision
Personal Time Off (PTO) program
Long‑Term Disability (100% paid)
Life Insurance (100% paid)
401(k) with immediate vesting and 3% salary match
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Duties
Investigate reports of non‑compliance with corporate and regulatory policies, including fraud, waste, or abuse.
Recommend methodologies to prevent improper conduct by identifying, assessing, and correcting non‑compliance in risk areas.
Utilize monitoring systems and data‑mining tools to track, remediate, and produce reports.
Handle all assigned investigations, follow‑ups, and resolutions.
Maintain judgement and discretion for sensitive or high‑profile cases, with intellectual rigor for complex, national‑scope fraud schemes.
Principal Duties and Responsibilities
Analyze public and internal data to determine if a full investigation is warranted and develop investigative strategy.
Collect evidence and documentation for adjudication.
Conduct on‑site audits of provider records to ensure billing appropriateness.
Interview providers, employees, members, and witnesses.
Prepare complex investigative and audit reports, presenting metrics, trends, and schemes to stakeholders, including enforcement agencies.
Craft well‑organized referrals explaining alleged fraud to regulators.
Coordinate investigations with law enforcement and regulatory agencies.
Understand organizational strategy and its linkages to related areas.
Make independent decisions about investigative methods with minimal direction.
Follow established guidelines and procedures.
Ensure compliance program meets OIG effective compliance program elements.
Manage a caseload of investigations, identifying schemes, tracking trends, and reporting non‑compliance.
Respond to alleged violations, evaluating or recommending investigative procedures.
Progress investigations from opening to final disposition with minimal assistance.
Develop new cases based on proactive data mining.
Respond to complaints, take statements, and document potential fraud, waste, or abuse.
Identify patterns and trends to generate new investigative leads.
Demonstrate teamwork and collaboration with other investigators.
Show adaptability in taking on varied investigative responsibilities.
Demonstrate experience with Medicare, Medicaid, ACA, and commercial managed care products.
Develop and facilitate training on Fraud, Waste, Abuse, HFH Non‑retaliation policy, Code of Conduct, and government program requirements.
Perform related duties as assigned.
Skills
Experience with RATSTATS or similar sampling programs.
Proficient in Excel for large data analysis, visualization, and automation (macros, pivot tables, Power Query).
Experience with Microsoft Power BI; knowledge of SQL preferred.
Excellent verbal, written, and presentation skills.
Ability to work with diverse backgrounds at all levels.
Objective, creative analytical and auditing skills.
Knowledge of health‑care industry product lines and payment methodologies.
Experience with FACETs or similar claim systems.
Strong personal and professional ethics.
Customer Service Responsibilities
Communication
Understanding
Sensitivity
Teamwork
Personal Qualities
Self‑directed
Flexible and committed to the team concept
Initiative and willingness to learn
Open to new learning experiences
Respectful of diversity without judgment
Demonstrated customer service values
Physical Demands / Working Conditions
Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
Sedentary work; occasional lifting of up to 10 lbs of force.
Requires sitting most of the time; occasional walking or standing.
Verbal communication required.
Hearing required.
Benefits
Medical and Dental (majority paid by FastTek)
Vision
Personal Time Off (PTO) program
Long‑Term Disability (100% paid)
Life Insurance (100% paid)
401(k) with immediate vesting and 3% salary match
#J-18808-Ljbffr