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Investigation Specialist I

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! The Investigations Specialist receives, researches, and reports on allegations of potential or actual fraud, waste, and abuse (FWA). In addition, the Investigations Specialist is required to identify and monitor utilization and billing trends that may indicate FWA. The Investigations Specialist leverages internal and external resources, including communications with members, facilities, clients, law enforcement, and other parties, to fully investigate potential or actual FWA.
You will...

  • Advises management team on issues relating to FWA investigations processes
  • Processes faxes, mail, email, and web requests (inbound and outbound) related to allegations or patterns indicating potential or actual FWA
  • Reports to management team bona fide allegations of potential or actual FWA
  • Assists management team with reports to and regular/ad hoc status calls with clients or law enforcement regarding allegations or patterns indicating potential or actual FWA
  • Collaborates with Network Services personnel to fulfill internal, client, or law enforcement requests for field investigations involving allegations or patterns indicating potential or actual FWA
  • Provide outreach and education to members, facilities, clients, law enforcement, and company personnel regarding FWA, as needed
  • Additional duties as assigned, including assisting and performing functions for other departments
We are excited to speak to some with the following...
  • High School Graduate or General Education Degree / Graduate Equivalency Degree (GED
  • 0+years' contact center or front office medical facility experience is strongly preferred
  • Excellent customer service and people skills; must be able to work independently and with teams
  • Ability to quickly learn new technology and processes
  • Must be able to understand and follow complex instructions
  • Read, write, speak, and understand English fluently

We value our team members and realize the importance of benefits for you and your family. Modivcare offers a comprehensive benefits package to include the following:
  • Medical, Dental, and Vision insurance
  • Employer Paid Basic Life Insurance and AD&D
  • Voluntary Life Insurance (Employee/Spouse/Child)
  • Health Care and Dependent Care Flexible Spending Accounts
  • Pre-Tax and Post -Tax Commuter and Parking Benefits
  • 401(k) Retirement Savings Plan with Company Match
  • Paid Time Off
  • Paid Parental Leave
  • Short-Term and Long-Term Disability
  • Tuition Reimbursement
  • Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare is an Equal Opportunity Employer.
  • EEO is The Law - click here for more information
  • Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
  • We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reach out to us at [email protected] .
  • Modivcare requires all employees to be vaccinated for COVID-19. Modivcare is an equal opportunity employer and consistent with federal, state, and local requirements, will consider requests for exemptions from this policy as required under the law.

Posted in February 10, 2023

Expired in May 11, 2023