Job Details

Special Investigations Unit Investigator

UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday through Friday 8:00 a.m. to 4:30 p.m. This is a remote position.

Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud, waste and abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential FWA. The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities related to assigned cases. This role includes supporting current SIU staff and manager with investigations and special projects.

Responsibilities:

• Maintain neat and organized files and electronic databases
• Prepare letters, memos, and reports
• Financial tracking
• Understand and adhere to HIPAA privacy requirements
• Proficiency with Microsoft Office products such as Word, Excel, Outlook and PowerPoint.
• Perform other duties as assigned
• Support all department personnel with duties including but not limited to investigations, audits, and regulatory referrals.

Qualifications:

• High School Diploma Strongly Preferred.
• Post-secondary education is preferred.
• One year of administrative support working experience is highly preferred.
• Must have proficiency with Microsoft Office Suite: Excel, Word, Outlook and Powerpoint.
• Must possess typing skills and working knowledge of word processing, electronic mail/calendar and spreadsheets.
• Must possess the ability to learn and effectively use various software programs.
• General knowledge and experience with office equipment such as copiers, multi-line phone systems, fax machines and paging systems

Preferred Qualification:

• Experience in investigations, claims, medical coding, auditing, compliance, risk management and/or data analysis required

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran