Fraud Investigation Supervisor supervises the development of policies and procedures for proactive fraud monitoring. Documents the current control process and recommends enhancements. Being a Fraud Investigation Supervisor collaborates investigation with appropriate business partners and local, state and federal authorities. Requires a bachelor's degree. Additionally, Fraud Investigation Supervisor typically reports to a manager or head of a unit/department. The Fraud Investigation Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Thorough knowledge of functional area under supervision. To be a Fraud Investigation Supervisor typically requires 3 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and we later discover someone else should have paid those medical bills, The Phia Group on behalf of the health plan will seek to recover the funds. The Case Investigator plays an important role in this effort, by determining whether another proper payer exists, and obtaining the details needed to pursue fund reimbursement.
The Health Claim Investigation Representative is responsible for communicating with plan members (insured participants) to determine potential sources of recovery (i.e. auto insurance, workers compensation, first party coverage, third party coverage, etc.). You will also be in contact with insurance carriers to collect adjuster and claim information while balancing communication with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email.
At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their dependents, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that has been named one of USA Todays top workplaces for 2024. We believe that this distinction, which stems from the fourth-annual survey co-sponsored by Energage and USA Today, reflects our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees.
Note: This is an onsite position, but we can provide a flexible teleworking schedule if appropriate.
Essential Duties and Responsibilities
Experience and Qualifications
The Phia Groups Commitment to Diversity
The Phia Group is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Phia Group is also committed to compliance with all fair employment practices regarding citizenship and immigration status.
Working Conditions / Physical Demands
Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines.
This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary.
External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.