Investigator, Specical Investigation Unit-Health Plan

nd validating data from the SIU analytics tool for decision-making purposes on identifying potential fraud.

Education & Experience

• Bachelor's degree required.

• Must hold credentials such as certification from the Association of Certified Fraud Examiners as a Certified Fraud Examiner (CFE), an accreditation from the National Health Care Anti-Fraud
  Association as an Accredited Health Care Fraud Investigator (AHFI)

• R

• Have previous law enforcement experience with a minimum of 3 years Medicaid or CHIP fraud, waste and abuse investigatory experience.

Knowledge, Skills & Abilities

• Knowledge of claim processing with advanced knowledge of medical benefits, medical terminology and coding.

• Proficient in ICD-10 and CPT coding.

• Knowledge of government programs (Medicaid & CHIP).

• Knowledge of data analysis and reporting.

• Must have Microsoft Office skills with Word and Excel.

Licensure, Registration, and/or Certification

• Certified Fraud Examiner or an Accredited Health Care Fraud Investigator required.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.