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Urgent! Fraud Analyst Job Opening In Myrtle Beach – Now Hiring PGBA
Description
***This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
***
Position Purpose:
Responsible for conducting investigations of complaints of irregular activity by evaluating, reviewing records, and analyzing information.
Performs compliance/fraud related investigations.
Communicates with providers, beneficiaries and/or suppliers as a major function of the position.
Logistics:
This position will be fully onsite located at 8733 Highway 17 Bypass, Myrtle Beach, South Carolina 29575.
What You'll Do:
Performs screening of complaints.
Determines developmental actions needed to resolve the complaint by contacting provider/facility, requesting medical records, or contacting beneficiaries.
Determines the classification of the fraud complaint and the steps needed to determine the validity and to resolve the complaint.
Assigns the complaint to the investigation staff member based on independent judgment and an analysis of the developed facts.
Responds to beneficiary and provider telephone inquiries.
Inputs initial fraud complaints information in the fraud and abuse case tracking system database for future case development and analysis.
Coordinates with management and appropriate entity as necessary.
Investigates complaints by communicating with beneficiaries and providers and researching claims/medical data.
Research facts and closes the complaints based on information gathered, collects overpayments, educates providers and beneficiaries, or refers cases to the appropriate entity for investigation.
Compile monthly and quarterly reports in a timely and accurate manner.
Establishes and maintains working relationships with internal and external sources of expertise for coordination of initial case development.
May address Hotline complaints.
Elicits necessary case initiation information from suppliers and determines the validity of the allegations.
Attends training workshops and seminars to remain abreast of the most current laws and regulations.
To Qualify for This Position, You’ll Need:
Required Education:
Bachelor's
Degree Equivalency:
Associate's plus 2 years job related work experience for a total of 3 years required experience.
OR
5 years of related work experience.
Required Work Experience:
1 year customer services, research/analysis, claims processing, education/training, medical affairs, or healthcare program management.
Required Skills and Abilities:
Strong customer service orientation.
Ability to effectively communicate both verbally and in writing to all levels throughout the organization.
Excellent analytical or critical thinking and problem-solving skills.
Ability to persuade, negotiate or influence.
Ability to review, analyze, and develop information and make appropriate decisions.
Working knowledge of or the ability to learn medical terminology.
Ability to work independently, prioritize workload, organize daily itinerary and travel.
Required Software and Tools:
Microsoft Office.
Preferred Education:
Bachelor's degree- Criminal Justice, Healthcare, Healthcare Administration, Health Promotion or Public Health.
Preferred Work Experience:
3 years-auditing/compliance, healthcare program management, investigation and fraud preventions.
Preferred Software and Other Tools:
Experienced with reporting, Microsoft Excel, Access or other database software.
Preferred Licenses and Certificates:
Certified Fraud Examiner (CFE), or Accredited Healthcare Fraud Investigator (AHFI).
What We can Do for You:
We offer our employees great benefits and rewards.
You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401K retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.
This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
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Unlock Your Fraud Analyst Potential: Insight & Career Growth Guide
Real-time Fraud Analyst Jobs Trends in Myrtle Beach, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Fraud Analyst in Myrtle Beach, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 62516 jobs in United States and 492 jobs in Myrtle Beach. This comprehensive analysis highlights market share and opportunities for professionals in Fraud Analyst roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! PGBA is currently hiring and seeking a Fraud Analyst to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: Fraud Analyst Jobs Myrtle Beach.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at PGBA adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a Fraud Analyst Jobs United States varies, but the pay scale is rated "Standard" in Myrtle Beach. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for Fraud Analyst typically include Financial Specialists and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your Fraud Analyst interview at PGBA, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the PGBA's products or services and be prepared to discuss how you can contribute to their success.
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