Fraud Detection Supervisor jobs in West Virginia

Fraud Detection Supervisor supervises fraud detection associates in their effort to detect possible customer fraud. Leads cross-functional initiatives to proactively detect and prevent fraud from occurring. Being a Fraud Detection Supervisor researches, documents, and implements best practices in the industry with regard to fraud detection. Leads the most challenging and complex fraud investigations. Additionally, Fraud Detection Supervisor requires a bachelor's degree. Typically reports to a manager or head of a unit/department. The Fraud Detection Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Thorough knowledge of department processes. To be a Fraud Detection Supervisor typically requires 3-5 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)

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SIU Fraud Analytics Specialist
  • The Health Plan of West Virginia Inc
  • Wheeling, WV FULL_TIME
  • The SIU Fraud Analytics specialist is part of a team focused on the prevention, detection, investigation, and reporting of healthcare fraud, waste, and abuse, program integrity initiatives, and the recovery of overpayments in a multi-payer environment. This is a data-intensive position. The Specialist is or will become a data mining and analysis expert, responsible for leveraging analytical tools to provide in-depth data analysis in support of fraud investigations, identifying outliers and/or aberrant billing patterns; potential fraud, waste, and abuse (FWA); and vulnerabilities or overpayments; as well as proactively generating leads for further investigation in pursuit of program integrity. The Specialist may occasionally assist other team members in fulfilling data requests and analytics for MFCU, the WVOIC, the ODI, the USAO and other law enforcement or regulatory entities. The Fraud Analytics Specialist will also conduct reviews of payment integrity matters (where fraud is not suspected), completing a thorough and ethical investigation.

    Required:

    • EDUCATION: Associate's degree in any field, with preference for degree in Criminal Justice, Data Analytics, Health Informatics, Health Information Management, or related field. (Two [2] years of relevant experience as described below in QUALIFICATIONS DESIRED section may be substituted for the required education.)
    • EXPERIENCE: At least 1 year of experience working with Microsoft Excel in a professional environment.
    • Advanced proficiency in Microsoft Excel; basic proficiency in Word, Outlook and other common programs.
    • Strong organizational and analytical skills.
    • Detail oriented, with a high level of accuracy.
    • Effective written and oral communication skills.
    • Ability to plan and execute projects independently and meet tight deadlines.

    Desired:

    • Education: Bachelor's degree in Accounting, Business, Criminal Justice, Data Analytics, Health Informatics, Health Information Management, or related field; or a Bachelor's degree in any field and a Master's Degree in any fraud-related discipline.
    • At least 2 years of relevant experience such as: SIU, healthcare fraud investigation, medical claim investigation, healthcare program integrity, data mining or analytics, healthcare claims payment processing, clinical experience, compliance, or certification as AHFI, CPC/CCP/CCS/CMC, or CFE.
    • Proficiency in fraud analytics.
    • Advanced technical skills related to data mining and analysis of healthcare claims data.
    • Experience with SQL/Microsoft Report Builder and Report Manager.
    • Experience in Medical Terminology and/or Coding.
    • Experience in a federally regulated environment such as Medicaid or Medicare Advantage.

    Responsibilities:

    • Leveraging analytic tools to provide in-depth data analysis in support of fraud investigations and payment integrity activities.
    • Conducting strategic analysis of healthcare claims data from initial data scoping through transformation and validation, and conveying results in verbal, written, and visual formats.
    • Analyzing healthcare claims data and other relevant information reactively, in response to allegations of FWA, and proactively, to identify trends and patterns indicative of FWA.
    • Utilizing fraud detection software and large data sets to identify outliers and inform decision-making related to FWA investigations and the identification and recovery of overpayments.
    • Obtaining, cleaning, normalizing, and validating healthcare claims data for the purposes of supporting FWA investigations and informing investigative and recovery decisions.
    • Drafting clear and concise, yet appropriately detailed reports of findings which may include recommendations related to case disposition, corrective actions, and/or process improvements.
    • Analyzing and synthesizing information from multiple sources including claims data, contracts, enrollment data, provider manuals, educational materials, bulletins, and state and federal regulations, to determine impact on claims payment as it relates to SIU cases or leads.
    • Responding to requests for information from various sources, including Medicaid, I-MEDIC, MFCU, and the WV OIC.
    • Expertise in the use of fraud detection software and case tracking system.
    • Creating and delivering training on databases, analytics software, and other relevant systems and techniques.
    • Identifying and recommending process improvements to reduce FWA.
    • Tracking, trending, and reporting identified metrics, including dashboard reporting.
    • Maintaining technical knowledge and skills by attending professional conferences and trainings, obtaining or retaining professional certification(s), and pursuing constant learning through membership in relevant professional organizations.
    • Investigating matters of payment integrity as assigned by the FWA Data Analytics Manager.

  • 7 Days Ago

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Investigator – Medicaid Fraud Control Unit
  • West Virginia State Attorney General’s Office
  • Charleston, WV FULL_TIME
  • To apply for any of the positions listed below, please submit a brief cover letter, your resume, salary requirements, a list of references, and any other information you believe would allow our Office...
  • 21 Days Ago

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Investigator – Medicaid Fraud Control Unit
  • Office of the West Virginia Attorney General
  • Charleston, WV FULL_TIME
  • To apply for any of the positions listed below, please submit a brief cover letter, your resume, salary requirements, a list of references, and any other information you believe would allow our Office...
  • 23 Days Ago

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Sales Executive, Fraud Solutions -Financial
  • TecTammina
  • Charleston, WV FULL_TIME
  • Company DescriptionCompany Description:Company Size: approx 700 on the Actimize side and 2300 on the Nice side = 3000 employees approx globally and growingFounded in 1999 Publicly tradedGrowing rapidl...
  • 14 Days Ago

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Supervisor
  • The Auto Spa Express
  • Martinsburg, WV FULL_TIME
  • We’re currently seeking individuals to join our team as a Supervisor at The Auto Spa Express in Martinsburg, WV! The Auto Spa Express is a state of the art, convenient, express car wash with free vacu...
  • 19 Days Ago

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Supervisor
  • Mountain Tidy WV
  • Morgantown, WV PART_TIME,FULL_TIME
  • Job Summary:We are seeking a highly motivated and experienced Supervisor to join our team. As a Supervisor, you will be responsible for overseeing daily operations, managing staff, and ensuring effici...
  • 3 Days Ago

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Juvenile Supervision Officer
  • Collin County
  • McKinney, TX
  • This position works a unique schedule of 12-hour shifts that provides 3 to 4 days off in a row every week. Starting at $...
  • 3/28/2024 12:00:00 AM

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Juvenile Supervision Officer
  • Midland County, TX
  • Midland, TX
  • Salary : $44,294.76 Annually Location : Midland, TX Job Type: Full-Time Job Number: 2019-00273 Department: Juvenile Dete...
  • 3/28/2024 12:00:00 AM

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Community Manager - Overlook Apartments
  • Asset Living
  • Palestine, TX
  • Company Overview Asset Living is a third-party management firm and a proven partner in fostering thriving communities na...
  • 3/28/2024 12:00:00 AM

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Community Supervision Officer I
  • Georgia Department of Community Supervision
  • Marietta, GA
  • Are you looking for an opportunity to make a difference in your community? Do you want to make a lasting impact on a per...
  • 3/27/2024 12:00:00 AM

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Assistant Community Manager - Canton Overlook
  • Humphrey Management
  • Baltimore, MD
  • We welcome applications from professionals in the hospitality, retail, restaurant, and construction industries. Humphrey...
  • 3/27/2024 12:00:00 AM

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Food Service Coordinator-FT supervisory role
  • Fresh Thyme
  • Food Service Coordinator-FT supervisory role page is loaded **Food Service Coordinator-FT supervisory role** **Food Serv...
  • 3/26/2024 12:00:00 AM

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Overlook Day Camp Counselor
  • Manheim Township
  • Lancaster, PA
  • Overlook Day Camp Counselor Department: Recreation Reports To: Youth Program Manager Supervisory Responsibilities: No Sa...
  • 3/24/2024 12:00:00 AM

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RN PD ED OVERLOOK
  • Atlantic Health System
  • Summit, NJ
  • Job Description Responsible for working with other healthcare professionals to help treat patients with various injuries...
  • 3/24/2024 12:00:00 AM

West Virginia (/vərˈdʒɪniə/ (listen)) is a state located in the Appalachian region in the Southern United States and is also considered to be a part of the Middle Atlantic States. It is bordered by Pennsylvania to the north, Maryland to the east and northeast, Virginia to the southeast, Kentucky to the southwest, and Ohio to the northwest. West Virginia is the 41st largest state by area, and is ranked 38th in population. The capital and largest city is Charleston. West Virginia became a state following the Wheeling Conventions of 1861, after the American Civil War had begun. Delegates from so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Fraud Detection Supervisor jobs
$52,671 to $66,683

Fraud Detection Supervisor in Beaumont, TX
PREVENT is a customer centric, browser based GUI application for Fraud detection, servicing.
January 11, 2020
Fraud Detection Supervisor in Alexandria, LA
Maintain awareness of member client fraud trends and suggest internal procedure changes to Fraud Management.
February 21, 2020
Fraud Detection Supervisor in Augusta, GA
They are preparing all the needed documents, researches and data that are evidence, which can bring great impact to refrain the presence of this fraud.
December 18, 2019