POSITION PURPOSEResponsible for conducting and leading internal and external investigations for designated lines of business (Commercial, OGB, FEP, ITS, Medicare Advantage, Vantage, etc.), to ensure payment integrity within the respective programs.
Refer suspected, detected, or reported cases of illegal drug activity, including drug diversion, to Centers for Medicare & Medicaid Servicesā National Benefit Integrity Medicare Drug Integrity Contractors (NBI MEDIC) and/or law enforcement and conduct case development and support activities for the NBI MEDIC and law enforcement.