Fraud and Abuse Specialist

<b>At LogistiCare, you have the ability to define your own career journey and enjoy the ride along the way and make possibilities real. Your growth is our objective. Whatever your passion, you’ll have the opportunity to find the career you’re looking for, learn and grow in your role, and make a difference in the lives of others. And you’ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first. <br/><br/>Sound like a good career fit? </b>

St Louis, MO


<strong><a href="" target="_blank" rel="noopener noreferrer">Who We Are: Transportation &amp; Integrated Health Services</a><br /></strong>Nation&rsquo;s largest manager of non-emergency medical transportation, provides 69+ million rides annually in 39 states and D.C. Supports integrated health care programs, improving care coordination for members and their corresponding providers and hospital networks.<br /><br /><strong>What We Value Most &ndash; YOU<br /><br />Benefits - The Whole Package&nbsp;</strong><br />Medical, Vision, Dental, Disability, EAP, Legal, Voluntary Life Insurance, Group Life &amp; AD&amp;D, Flexible Spend Account, Paid STD &amp; LTD, Vacation &amp; Holidays<br /><br /><strong>Culture - Why You Want to Come to Work Every Day</strong><br />Casual Dress - Business Casual, Relaxing - Comfy Lounge Areas, Excitement -Themed&nbsp; Luncheons, Great Hours &amp; Set Shifts - (Mon. &ndash; Fri.)<br /><br /><strong>View Featured Positions Below OR Check Out <a href=";d=ExternalCareerSite" target="_blank" rel="noopener noreferrer">All&nbsp;Career Journey Opportunities&nbsp;with LogistCare</a></strong>

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Overview: The Fraud and Abuse Specialist identifies utilization and billing trends that may signal potential fraud and/or abuse before the trip occurs. Associate outreaches to facilities, members and health plans as relevant to conduct investigations and to complete any action required based on findings.
Responsibilities: <ul> <li>Contacts facilities to verify appointments and treatments</li> <li>Establishes safeguards against fraud, waste, and abuse</li> <li>Researches, identifies and investigates requests that have potential fraud/abuse</li> <li>Validates coverage benefits/level of service and mileage reimbursement</li> <li>Works to reduce trip distance by confirming that member is utilizing closest medical facility or has relevant trip exception in place to cover</li> <li>Other duties as assigned</li> </ul>
Requirements: <ul> <li>Competency Statement(s)</li> <li>Analytical Skills - Ability to use thinking and reasoning to solve a problem</li> <li>Communication, Oral - Ability to communicate effectively with others using the spoken word</li> <li>Communication, Written - Ability to communicate in writing clearly and concisely</li> <li>Customer Oriented - Ability to take care of the customers' needs while following company procedures.</li> <li>Decision Making - Ability to make critical decisions while following company procedures.</li> <li>Interpersonal - Ability to get along well with a variety of personalities and individuals.</li> <li>Management Skills - Ability to organize and direct oneself and effectively supervise others.</li> <li>Problem Solving - Ability to find a solution for or to deal proactively with work-related problems</li> <li>Relationship Building - Ability to effectively build relationships with customers and co-workers Working Under Pressure - Ability to complete assigned tasks under stressful situations</li> <li>Time Management - Ability to utilize the available time to organize and complete work within given deadlines</li> <li>Investigative Skills - Ability to research information to identify trends and anomalies</li> <li>REQUIREMENTS <ul> <li>Education: High School Graduate or General Education Degree (GED) required</li> <li>Experience: Preferred front office medical experience, medical case management and/or medical social work experience</li> <li>Six months to one year prior contact center experience and/or prior customer service experience</li> </ul> </li> <li>Skills <ul> <li>Strong reporting, spreadsheet and database skills</li> <li>Must possess ability to correspond professionally both verbally and in writing</li> <li>Excellent customer service and people skills and must be able to work independently or with a team</li> <li>Ability to quickly learn new technology and processes</li> <li>Must be able to understand and follow complex instructions</li> <li>Must be able to learn and acquire proficiency in LogistiCare's Proprietary software application(s)</li> <li>Read, write and understand English fluently Bi-lingual a plus</li> <li>Ability to accurately type 35wpm</li> </ul> </li> <li>WORKING CONDITIONS</li> <li>Physical Demands <ul> <li>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> </ul> </li> <li>Physical Requirements <ul> <li>Able to sit at and work on a computer for periods of time</li> <li>Able to use the phone for periods of time</li> <li>Able to lift up to 10 pounds and reach/bend to retrieve items in cabinets and shelves</li> <li>Required to be at the work location to perform job functions</li> <li>Ability to speak, hear and see for the assigned work day</li> <li>Repetitive key stroke/data entry for the assigned work day</li> <li>Ability to ambulate as needed for the assigned work day</li> <li>Ability to meet the requirements of the Customer Service Representative job description</li> </ul> </li> <li>WORK ENVIRONMENT <ul> <li>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> <li>Entire work time is conducted in an office environment in a controlled atmosphere building.</li> <li>The noise level in the work environment is usually moderate.</li> </ul> </li> </ul> LogistiCare is an Equal Opportunity Employer.