Investigator

By | November 2, 2022

Job Responsibilities : Investigator

Salary : $53400 per year

Company : HealthFirst

Location : Remote US

The Sr Investigator is responsible for carrying out complex investigations of alleged misconduct by Providers Representatives Employees and Members.

Conduct investigations of Providers Employees Representatives and Members and compile data into written reports. Investigations may be of a more complex nature i.e. multiple allegations; Medicaid investigations or investigations involving extensive research income verifications and other criteria for eligibility.

Research investigations; prepare review and edit investigation reports for submission to Director SIU and also Fraud Waste and Abuse Committee.

Log investigations.

Manage and complete various projects i.e. Enrollment and Verification Project as assigned.

Collect utilize and interpret data obtained from a variety of computer generated reports and other sources thereby identifying and documenting questionable patterns related to operation and other practices which merit further investigation.

Inform the Special Investigations Unit Director and Supervisor of potential or actual problem areas. Identify and suggest corrective action or improvement.

Assist Special Investigations Unit Director and Supervisor with Fraud Waste and Abuse issues and perform other duties as necessary or assigned.

Maintain assigned investigation files document evidence and prepare comprehensive investigation reports

Maintain good working relationship with Healthfirst employees and all outside contacts of the Special Investigations Unit Department including Federal State and Local law enforcement agencies.

Since we care so greatly about our employees’ and members’ wellbeing Healthfirst has implemented various COVID-related health and safety requirements for our workforce. Employees are expected to follow the Company’s current COVID-19 or other infectious disease health and safety protocols including local requirements which may include sharing information regarding your vaccine status and mask wearing. Protocols may change in the future with the evolving public health landscape. Healthfirst will consider accommodation requests as required by applicable law.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race color religion gender gender identity sexual orientation national origin age genetic information military or veteran status marital status mental or physical disability or any other protected Federal State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org or not one of our recruitment partners please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

Greater New York City Area (NY NJ CT residents): $56000 – $74880

All Other Locations (within approved locations): $48600 – $70720

As a candidate for this position your salary and related elements of compensation will be contingent upon your work experience education licenses and certifications and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary Healthfirst offers employees a full range of benefits such as medical dental and vision coverage incentive and recognition programs life insurance and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

  • The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire or for a job promotion or transfer into this role.

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