Aetna SIU Sr Investigator - NJ Health Plan in Princeton, New Jersey
Req ID: 45752BR
Aetna Better Health of New Jersey is hiring a SIU Senior Investigator to support our NJ Health Plan
Role is office based in Princeton, NJ.
Summary: Conducts more high level, complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare and disability fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices. Oversees Corporate activities related to the prevention, investigation and prosecution of health care and disability fraud and to recover lost funds. Responsible for compliance with state and federal regulations mandating the reporting of Corporate fraud related activities and the preparation of Corporate Anti Fraud Plan
(*) Conducts more high level, complex investigations of known or suspected acts of healthcare/disability fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involving multi-disciplinary provider groups, or cases involving multiple perpetrators or intricate healthcare fraud schemes.
(*) Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members
(*) Researches and prepares cases for clinical and legal review
(*) Documents all appropriate case activity in case tracking system
(*) Makes referrals, both internal and external, in the required timeframe
(*) Facilitates the recovery of company and customer money lost as a result of fraud matters
(*) Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators
(*) Assists Investigators in identifying resources and best course of action on investigations
(*) Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
(*) 3-5 years investigative experience in the area of healthcare/disability fraud and abuse matters
(*) Prior experience in the NJ market will be preferred
(*) College degree in Criminal Justice or a related field.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Legal