Fraud Analyst - Medicare

This position is located in Miramar, FL.

Hewlett Packard Enterprise creates new possibilities for technology to have a meaningful impact on people, businesses, governments and society. HPE brings together a portfolio that spans software, services and IT infrastructure to serve more than 1 billion customers in over 170 countries on six continents. HPE invents, engineers, and delivers technology solutions that drive business value, create social value, and improve the lives of our clients.

Learning does not only happen through training. Relationships are among the most powerful ways for people to learn and grow, and this is part of our HPE culture. In addition to working alongside talented colleagues, you will have many opportunities to learn through coaching and stretch assignment opportunities. You’ll be guided by feedback and support to accelerate your learning and maximize your knowledge. We also have a “reverse mentoring” program which allows us to share our knowledge and strengths across our multi-generation workforce.

SafeGuard Services (SGS), a subsidiary of Hewlett-Packard Enterprise Services, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

Since 1999, SGS has prevented more than $7.5 billion in inappropriate payments, consisting of over $4.7 billion in proactively Prevented Dollars and $2.8 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of hundreds of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.

Position Overview:

The position requires the individual to use a variety of tools to initiate investigations, identify subjects and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.

Essential Functions:

  • Ability to perform research and draw conclusions
  • Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
  • Ability to organize a case file, accurately and thoroughly document all steps taken
  • Ability to compose correspondence, reports and referral summary letters
  • Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
  • Ability to communicate effectively, internally and externally
  • Ability to interpret laws and regulations
  • Ability to handle confidential material.
  • Ability to report work activity on a timely basis.
  • Ability to work independently and as a member of a team to deliver high quality work
  • Ability to attend meetings, training, and conferences, overnight travel required

Prerequisite:

Education and Experience Required:

  • Bachelor degree preferred and one to two years of investigative experience
  • Strong investigative skills
  • Strong communication and organization skills
  • Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
  • Strong PC knowledge and skills
  • Bi-Lingual English/Spanish preferred

Hewlett Packard Enterprise Values:

Partnership first: We believe in the power of collaboration – building long term relationships with our customers, our partners and others

Bias for action: We never sit still – we take advantage of every opportunity

Innovators at heart: We are driven to innovate – creating both practical and breakthrough advancements

HPE is an EOE / Female / Minority / Individual with Disabilities / Protected Veteran Status

What do we offer?

Extensive social benefits, flexible working hours, a competitive salary and shared values, make Hewlett Packard Enterprise one of the world´s most attractive employers. At HPE our goal is to provide equal opportunities, work-life balance, and constantly evolving career opportunities.

If you are looking for challenges in a pleasant and international work environment, then we definitely want to hear from you. Apply now below, or directly via our Careers Portal at www.hpe.com/careers

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