Point32Health

Investigator II

Canton, MA · Mid

Sponsorship not specified$81k-$121kDetected 2 days ago

AccountingResearch

About the role

/Duties - what you will be doing (top five):
Apply laws, regulations, plan policies and guidelines, contract provisions, coding rules, coverage rules, and industry standards to information gathered during the investigation.
Complete detailed reports of investigative activity and prepare summary findings notices for providers or other entities.

The Investigator works closely with other members of the SIU to set investigative priorities, develop effective investigative strategies and techniques, and recommend measures to address new and evolving schemes.
Develop new investigations based upon case findings.
Work with the analytics and intake team to develop and refine data mining to address new and evolving schemes.
Educate and collaborate with various business units to raise awareness of potential FWA concerns.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Must be able to work under normal office conditions and work from home as required.
May be required to work additional hours beyond standard work schedule.
They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Degree preferably in a clinical or scientific field, business, accounting, computer science, or criminal justice.
Familiarity with and/or experience in Applied Behavior Analysis (ABA)
Board Certified Behavior Analyst (BCBA) certification preferred.
Certified Professional Coder ("CPC")
Certified Fraud Examiner ("CFE") designation a plus.
Preferred: Degree preferably in a clinical or scientific field, business, accounting, computer science, or criminal justice.
Preferred: Experience in audits/investigations including experience drafting and distributing summary findings notices to providers or other entities.

$80,741.22 -$121,111.82
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.
The actual salary for this position will be determined by several factors, including the scope and complexity of the role
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay.
Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare.
Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background
it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions.
We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
Learn more about who we are at Point32Health.
Perform out-of-the-box thinking, collaborate with others, and make a difference every day!

This listing is sourced directly from Point32Health's careers page and normalized into a canonical job model.