LOCATION: Henderson Road, Tampa, FL
REPORTING TO: Senior Manager
Fulfill, as part of a team, fraud, waste, abuse, and other compliance reporting requirements in multiple states, with numerous governmental agencies, across all lines of business. Retrieve, analyze, and compile data and other information necessary for health insurance industry regulatory reporting and in response to various information requests. Prepare reports and other documents to be submitted to regulatory and other governmental agencies and business partners. Conduct research of statutory, regulatory, and contractual requirements. Enter data and other information into case and work management tracking system.
- Retrieve, analyze, and compile data and other information necessary for health insurance industry regulatory reporting and in response to various information requests.
- Prepare reports and other documents to be submitted to regulatory and other governmental agencies and business partners.
- Conduct research of statutory, regulatory, and contractual requirements.
- Maintain organized files.
- Develop knowledge of health care anti-fraud investigative activities.
- Maintain confidentiality of all sensitive information.
- Participate in meetings and training as required.
- Monitor and report to management on the status of assigned projects, anticipating and identifying issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies.
- Contribute to continuous improvement of work product and processes.
- Handle Fraud Hotline call intake and initial response.
- Enter into case and work management system information and data relating to complaints, cases, requests for information, and other incidents or matters.
- Perform special projects and other duties as assigned.
- Communicates the importance of compliance and the compliance program to health plan staff, which includes promoting (1) increased awareness of the Corporate Ethics and Compliance Program, (2) understanding of new and existing compliance issues and related policies and procedures, and (3) importance of internal compliance audits.
- Develops and maintains productive relationships with all levels of management as well as regulators and other relevant external parties.
- Performs special projects, as assigned.
- Required A High School or GED
- Preferred An Associate's Degree in a related field
- Required 5 years of experience in a professional health care setting handling multiple complex tasks, including working with spreadsheets and performing data analysis.
- Preferred Other Previous experience working with governmental health care regulations
- Preferred Other Previous experience with health care fraud, waste, and abuse investigations.
Licenses and Certifications:Technical Skills:
- Intermediate Other Ability to understand and follow verbal instructions and written policies and procedures.
- Intermediate Other Ability to understand and work with complex statutory, regulatory, and contractual requirements.
- Required Intermediate Microsoft Excel
- Required Intermediate Windows Operating System
- Required Intermediate Other Ability to learn and work effectively with other business computing and operating systems and databases.