• Special Investigative Unit Auditor, IN - Hybrid…

    McLaren Health Care (Indianapolis, IN)


    We are looking for a Special Investigative Unit Auditor to join us in leading our organization forward.

     

    McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

     

    McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.

     

    As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

    McLaren Health Plan is our Michigan-based

    health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at

     

    https://www.mclarenhealthplan.org

     

    MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.

     

    Learn more about MDwise, Inc. at

     

    https://www.mdwise.org/

    Position Summary:

    Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products for assigned Plan. Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.

     

    This is a hybrid position with requirements to come onsite as scheduled, Indianapolis, IN.

     

    Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

    #LI-AK1

    Qualifications:

    Required:

    + Associate Degree in business, health care or related field.

    + Three (3) years’ experience inprogressively more responsible positions using analytical skills with at least two (2) years’ experience in compliance or related function.

    Preferred:

    + Bachelor’s Degree in business, health care or related field.

    + Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC.

    + Two (2) years’ experience and knowledge of HMO, or PPO (e.g. accounting/finance, reinsurance, regulatory compliance, claims processing, membership/eligibility, and actuarial precepts).

    + Course work or work experience in statistics.