Job Description

Zurich North America is hiring an Medical Provider Claims Fraud Investigator to join our team! We are open to hiring talent in the following locations: The candiate must live in Southern California (Los Angeles county to the Southern Boarder of California).

Key Responsibilities: Southern California Major Case Medical Provider Investigator

• Conduct thorough investigations into medical provider cases involving potential fraud or abuse.
• Collect, analyze, and interpret complex medical records, billing data, and other relevant documents.
• Collaborate with internal teams, including claims adjusters, legal, and medical professionals, to develop comprehensive investigation strategies.
• Conduct interviews with medical providers, claimants, witnesses, and other parties as necessary.
• Prepare detailed investigative reports, including findings, conclusions, and recommendations for further action.
• Testify at legal proceedings as required to support investigation findings.
• Stay current with industry trends, regulatory requirements, and best practices related to medical provider investigations.
• Adheres to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations.

Basic Qualifications:

• Bachelors Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area
  OR
• Zurich Certified Insurance Apprentice, including an Associate Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area
  OR
• High School Diploma or Equivalent and 6 or more years of experience experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area
  AND
• Knowledge of regulations and statutes pertaining to claims law
• Knowledge of claims process
• Microsoft Office experience

Preferred Qualifications :

• Previous experience working with insurance companies or within the healthcare industry (Medicare/Medicaid).
• Demonstrated expertise in handling complex and high-stakes medical provider investigations.
• Bilingual in Spanish a plus
• CPT Coding knowledge a plus
• Expertise in using Excel for complex data manipulation, pivot tables, and advanced formulas.
• Experience in designing professional PowerPoint presentations for senior management or legal proceedings.
• Self-motivated, able to drive cases forward independently.

At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here . Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply, as they will be considered based on their experience, skills, and education. The salary indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $71,100.00 - $116,500.00.

As an insurance company, Zurich is subject to 18 U.S. Code § 1033. 

 

As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ().

A future with Zurich. What can go right when you apply at Zurich?

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.

As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet 

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. 

Location(s): AM - California Virtual Office, AM - Los Angeles, AM - Woodland Hills, AM - Irvine, AM - San Diego, AM - Pasadena, AM - San Bernardino, AM - Hollywood (CA)
Remote Working: Hybrid
Schedule: Full Time
Employment Sponsorship Offered: No 

 
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE #LI-REMOTE 

Job Tags

Similar Jobs