Job Description
HMSA is seeking an Investigator I for their Special Investigations Unit. The role involves managing fraud, waste, and abuse allegations, conducting investigations, and coordinating with various entities to resolve cases. Responsibilities Manage FWA case investigations, collaborate with federal, state and law enforcement entities, and provide applicable notifications as required Maintain extensive documentation and evidence for SIU cases Recommend and implement preventive measures to combat FWA schemes including, but not limited to provider education, policies, claims edits and payment suspensions Manage the recovery, allocation and documentation of health plan funds resulting from FWA findings Manage the intake, documentation and resolution of FWA referrals to SIU Coordinate with internal and external partners on FWA allegations Assess needs, make recommendations and complete timely reviews in accordance with all regulatory requirements Create and maintain internal policies and procedures, workflows and presentations and present as needed to internal and external entities Support regulatory audits and RFIs from law enforcement and federal and state entities Represent SIU at cross functional workgroups and meetings and present case recommendations to other applicable business areas including, but not limited to Legal, Medical Management, Provider Operations and Claims Administration Perform all other miscellaneous responsibilities and duties as assigned or directed Skills Bachelor's degree and one (1) year of related work experience; or equivalent combination of education and related work experience Fundamental knowledge/awareness of Fraud, Waste and Abuse Strong oral and written communication skills Basic working knowledge of Microsoft Word, Excel, and PowerPoint Intermediate working knowledge of Microsoft Outlook Company Overview HMSA is an insurance company that provides affordable health plans, employee benefits services and worksite wellness programs. It was founded in 1938, and is headquartered in Honolulu, Hawaii, USA, with a workforce of 1001-5000 employees. Its website is