WI3650698

1

Bachelor's Degree

Bachelors Degree

$53545 + yearly

Unspecified

40

JOB REQUIREMENTS: Putting People First in Pharmacy- Navitus was founded
as an alternative to traditional pharmacy benefit manager (PBM) models.
We are committed to removing cost from the drug supply chain to make
medications more affordable for the people who need them. At Navitus,
our team members work in an environment that celebrates diversity,
fosters creativity and encourages growth. We welcome new We are unable
to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi,
New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina,
South Dakota, West Virginia, and Wyoming. The Investigator I, SIU will
assist the Sr. Manager, Compliance and SIU and SIU Investigators in the
execution and maintenance of the Navitus fraud, waste and abuse program,
including controls, policies & procedures, communications and training.
The Investigator I will work in a semi-professional role with an
intermediate level of independence, to ensure case referrals are
investigated, SIU program elements are implemented and controls are
examined periodically for effectiveness and efficiency. The Investigator
I will work closely with the investigators and serve in a back-up role
to the investigators for projects that involve fraud detection,
reporting and recommendations. The role requires knowledge of
investigative processes, data mining and claims review, ability to read
and understand regulations and have general knowledge of pharmacy. The
Investigator I shall have the ability to be self-initiating for
projects, seeking supervisory guidance where appropriate. The
Investigator I will periodically receive direction and oversight of work
from the Investigator II. Is this you? Find out more below! How do I
make an impact on my team? Assist SIU team in the development, execution
and maintenance of the Navitus fraud and abuse program, including
controls and guidance. Independently investigate cases of potential
abuse in accordance with the investigation protocols and procedures,
including final analyses. Under the direction of an SIU Investigator,
proactively identify potential FWA fraud schemes, and investigate
fraudulent activities where there is intentional deception,
misrepresentation, or concealment made by an individual or entity
knowing that the deception could result in some unauthorized benefits to
the individual, the entity, or some other party. Under the direction and
guidance of the SIU team, analyze claims data for cases and/or potential
fraudulent activities identified by Plan Sponsors, including reports
such as the CMS high risk report, received through HPMS alerts, or from
law enforcement. Periodically provides updates on certain FWA activities
to the FWA Committee. Identify risks and develop resolution for the
controls and compliance with the exclusion review process\.... For full
info follow application link. Navitus Health Solutions is an Equal
Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other
\*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/5C5FBDCC1B3D4EAE