Investigation Project Assistant Jobs

Strong organizational and project management abilities.

Ongoing Workshops: Conduct regular workshops and refresher sessions to ensure consistent knowledge and skills application.

Scenario-Based Training: Facilitate role-plays and training sessions based on real-life fraud scenarios to ensure practical application of knowledge.

Regulatory Compliance Training: Equip the fraud team with knowledge on regulatory standards, ensuring all investigations are compliant.

A minimum of three years of experience in fraud investigations.

Excellent communication skills, both written and verbal.

1-2 years of experience within risk management, fraud prevention, or Trust and Safety.

When trends or product vulnerabilities have been identified, you are able to escalate to the Product Support Job Family.

Experience working with Jira ticketing system required.

Strong investigative ability, internet research, organizational, and analytical skills.

Ability to detect vulnerabilities in existing and new products or features, and anticipate the ever-evolving fraudulent behaviors.

Strong communication skills, both written and spoken, self-motivated and results-oriented.

Conducting objective, fair, thorough, unbiased and timely investigations in accordance with requirements of Office for People With Developmental Disabilities (OPWDD)

Monitoring the Incident Report and Management Application (IRMA) via OPWDD website on a daily basis, and removing incidents from the queue

Excellent interpersonal communication skills required.

Excellent critical thinking skills, organizational skills and follow up skills

Obtaining and analyzing documentary evidence

Identifying and interviewing subjects and witnesses to the allegation

· When violations are noted or observed, they are immediately reported to management.

Conducts investigations into complex and abstract deviation events for products produced at BIAH.

· Participates on investigation related project teams to evaluate events, which are investigated.

· Completes maintenance of systems associated with the investigation function.

· Investigation reports and impact assessments are complete and compliant with regulations.

· Submits data for weekly/monthly KPI reports.

(Equivalent combinations of education, licenses, certifications and/or experience may be considered)

Assist Loss Investigation Supervisor in training Security Agents and with "In Store" training, while continuing to enhance personal knowledge.

2 years related Security/Loss Investigation experience required

Identify, coordinate, and perform all loss investigation, prevention, and physical security tasks as assigned.

Observe and report safety and physical security concerns to Loss Investigation Supervisor.

Prepare and maintain detailed reports on information gathered during the course of an investigation.

Demonstrate knowledge of and adherence to EH&S safety requirements for site

Display knowledge in cGXP, manufacturing operations, batch disposition, and Aseptic principles and concepts

Excellent written and verbal communication and interpersonal skills

Demonstrate strong knowledge/understanding of the principles and concepts of aseptic technique and manufacturing operations.

Ph.D. with 0-2 years of experience in investigation or reviewing manufacturing and laboratory investigations roles in Pharma industry .

Knowledge of current Good Manufacturing Practices and the applicable GxP regulations and standards

Investigate claims in order to provide information that is missing or cannot be determined by processors

Contact providers and members to obtain information necessary to process claims

Screen, code, count, and sort batches and logs all work to be distributed to staff

Ensures prompt and efficient distribution of work

Research provider numbers on the claims system to ensure accurate processing

A High School diploma or equivalent

Able to work with others in a fast-paced, team environment and to interact effectively with all levels of management

Excellent written and verbal communications skills

Interpersonal skills; proven ability to develop skill-set to meet and exceed performance standards

Skills that will help you in the role:

Managing assigned case volume and ensuring adherence to department quantity and quality standards

Identifying service delivery failures and escalating issues or impact to appropriate business owners and leadership

Conduct investigations of potential waste, abuse, and fraud

Document activity on each case and refer issues to the appropriate party

Perform data mining and analysis to detect aberrancies and outliers in claims

Develop new queries and reports to detect potential waste, abuse, and fraud

Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions

Assist with complex allegations of healthcare fraud