Prime Therapeutics
Lansing, MI, USA
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make. Job Posting Title SIU Investigator Job Description The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential 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 audit and 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 investigative plans, documents and justification to support investigations; evaluate impact of...