· An employer in the San Antonio, TX area is looking for a remote SIU Life and Health investigator. As a dedicated SIU Life & Health Investigator you will review, analyze and investigate all life, health and waiver of life insurance premium claims to ensure claim validity and legal liability/risk management. You will also provide recommendations on claim settlements and assist with fraud detection and deterrence, consults with Legal and Life Underwriting teams and external medical providers as appropriate, as well as monitor appropriate loss and expense claims reserves. As a Mid-Level Life SIU Investigator for Medicare Supplement Fraud, Waste, and Abuse you will support the Life Special Investigations team that is responsible for increasing fraud awareness throughout USAA and its membership, developing innovative fraud detection and prevention programs, and investigating cases of suspected fraud for Life Company.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com.
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· Certification or extensive experience in medical coding (CPT codes, ICD-10 codes).
· Proven experience in fraud investigation within the health claims sector.
· Knowledge of Medicare supplement claims.
· Strong understanding of medical terminology.
· Proficiency in data analysis and analytics.
Proficiency in Microsoft Office tools.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.