Fraud Investigator

Lyra seeks a highly skilled and experienced contractor to play a pivotal role in supporting our
Fraud, Waste & Abuse (FWA) and complaint handling processes. The successful candidate will be adept at navigating complex situations, possess a nuanced
understanding of Lyra's policies and procedures, and demonstrate exceptional communication and interpersonal skills.
Key Responsibilities:
Investigation and Resolution of FWA and Complaints: Conduct thorough and timely
investigations into allegations of fraud, waste, and abuse, as well as other complaints.
This will involve gathering and analyzing evidence, interviewing relevant parties, and
making informed recommendations for resolution.
Policy Interpretation and Application: Demonstrate a comprehensive understanding
of Lyra's policies and procedures, and apply them judiciously to complex and nuanced
situations. This is a 30hr work work role.
Cross-Functional Collaboration: Serve as a liaison and subject matter expert for
cross-functional teams, including Legal, Compliance, Clinical Operations, and Provider
Relations.
Documentation and Reporting: Maintain meticulous records of investigations,
communications, and case outcomes. Prepare clear and concise reports for internal
stakeholders and regulatory bodies as needed.
Process Improvement: Identify opportunities to enhance the efficiency and
effectiveness of FWA and complaint handling processes. Contribute to the development
and implementation of best practices.

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, 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 Human Resources Request Form. The EEOC "Know Your Rights" Poster is available here.

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .

Responsibilities
Handle performance-related complaints about providers, conduct outreach to
gather insights, and collaborate with internal teams to take corrective actions.
Support with Fraud, Waste & Abuse (FWA) investigations, outreach, coordination
and dashboard reviews.
Provide recommendations and support for initiatives to continuously refine and
improve our data review processes to maximize effectiveness.
Collaborate with cross-functional teams to ensure alignment on outreach
approach and timing.
Qualifications
3-5 years combined relevant work experience.
Previous experience with Fraud, Waste & Abuse (FWA) investigations.
Bachelors degree in Healthcare Administration, Business Administration or
Communications, a plus.
Ability to work independently, multi-task and maintain strong attention to detail.
Proficiency in using Tableau, or a similar platform, to analyze data and translate it
into actionable insights.
Experience with CRM systems (e.g., Salesforce) and ticketing platforms (e.g.,
Zendesk) a plus.
Excellent written and verbal communication skills, with experience conducting
outreach.

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.