2 siu investigator jobs found

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Special Investigations Unit (SIU) Investigator - Remote Job Description The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential pharmacy, member, and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively identifies improvement opportunities in investigation procedures and FWA prevention efforts ensure proper identification of potential FWA. The SIU Investigator prepares investigative reports for leadership, remediation actions, recovery efforts, internal committees and/or referral to state and federal law enforcement agencies. Responsibilities Develop...

Our Company Amerita Overview This role will be responsible for verifying patient medical and pharmacy coverage, investigating authorization requirements, and facilitating patient copay card assistance based on eligibility criteria. Schedule: Monday - Friday9:00am - 6:00pm -Competitive Pay -Health, Dental, Vision & Life Insurance -Company-Paid Short & Long-Term Disability-Flexible Schedules & Paid Time Off-Tuition Reimbursement -Employee Discount Program & DailyPay-401k -Pet Insurance Responsibilities Verifies patient prescription benefits, including medical and pharmacy coverage, to ensure accurate billing and reimbursement Investigates authorization requirements for medications and any ancillary supplies, collaborating with healthcare providers and insurance companies as necessary Determines patient eligibility for copay card assistance programs based on program criteria and facilitate enrollment as appropriate...