Benefit Integrity Analyst (Omaha, NE)

IntegriGuard has an opportunity for a Benefit Integrity Analyst to prepare and complete investigations and cases based upon analysis of allegations and information from internal and external sources. The successful individual will review and analyze complaints received to determine the best procedure for handling the file or investigating the complaint, identify overpayments based on investigation results, develop investigations for referral to law enforcement, prepare presentations, communicate details of investigations to appropriate parties and support Law Enforcement on referred cases, perform data analysis to pattern and trend fraud schemes and scams, proactively initiate and develop investigations from information received internally or externally, and enter and update information in all tracking systems within established time frames.

Experience/Education/Abilities

High school diploma or GED required. Bachelor’s or Master’s degree preferred.
At least two years of experience in benefit integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions.
2 or more years experience in claims analysis for medical insurance, Medicare, or Medicaid is preferred.
College or technical courses related to the position (e.g., law enforcement, investigation, statistics, data analysis) are preferred.
Preferred knowledge and understanding of Medicare statutes, regulations, policies, claim processing, servicing, audit and reimbursement principles and procedures.
Excellent written and verbal communication skills including public speaking and human relations, and ability to produce work free from typographical or spelling errors.
Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements.
Shows longevity in employment with one or more past employers.
Not currently sanctioned or excluded from the Medicare program by the OIG.
Working knowledge of Microsoft Office, Internet and e-mail.

Send your resume to us in one of three ways:

E-mail: humanresources@integriguard.org

Mail:
Human Resources
IntegriGuard
2121 North 117 Avenue, Suite 200
Omaha, NE 68164

Fax: 402.498.2534

IntegriGuard is an Equal Opportunity and Affirmative Action Employer.

Any questions regarding benefits can be directed to: humanresources@integriguard.org