Fraud Detection Supervisor jobs in Weymouth, MA

Description

The Supervisor for Responsible for supervising all activities and personnel associated with performing tasks and work processes assigned to the group. Actively participate as a member of the department management team and the larger organization in support of business objectives.  

Essential Job Functions

Staff

• Train and develop team through challenging assignments
• Cross-train and build redundant capabilities within team
• Supervise daily activities to ensure group and individual productivity
• Create yearly performance reviews with informal quarterly feedback 

Operations

• Manage staff and workload to complete work in timely and accurate manner
• Preparing and processing requests for copies of medical records or other documents for consumers, PCAs, attorneys and other parties involved in legal cases involving consumers/PCAs
• Maintaining confidentiality of consumers/PCAs records by following TU policies and procedures, federal and state regulations regarding disclosure of protected health information(PHI)
• Processing all subpoena requests. Ensures there is a valid authorization signed by the consumer/PCA accompany with the subpoena
• Assis with coverage of Compliance Orientation when Compliance Manager is out
• Complete SAF for Compliance/Fraud/Subpoenas
• Handle the research of PA and MA Grievances Inboxes, providing information to Compliance Manager.
• Coordinate the MA Grievance Semi Annual spreadsheets for submission to MassHealth (Jan and July).
• Develop, measure, and report meaningful key metrics
• Establish group targets and strategy for achieving targets
• Identify, design, and implement process improvements
• Use technology to reduce manual effort and resulting rework
• Support other department functions as necessary
• Perform other duties as assigned

Communication

• Coordinate with other functions in payroll & billing to streamline workflows/handoffs
• Lead department meetings
• Liaise with other departments as necessary
• Serve as point of escalation for external contacts
• Encourage and provide free flow of bi-directional communications
• Communicate with Tempus attorney and outside legal firms

Other

• Support overall mission and objectives of Tempus Unlimited
• Must report all suspected incidents of consumer sexual abuse, physical abuse and neglect to the Disabled Person Protection Commission (D.P.P.C.).

Requirements

Requirements

• Ability to supervise and direct staff
• Excellent organizational skills
• Attention to accuracy and detail
• Strong interpersonal skills – telephone skills
• Excellent oral and written communication
• Good computer and analytical skills
• Innovative thinking

Other Skills/Abilities

• Familiarity with Fraud functions & PCA program procedures and regulations
• Ability to maintain confidentiality

Required Education and Experience

• High School Diploma

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers and scanners.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk and/or hear. The employee is frequently required to sit; stand; walk; use hands and fingers and also must be able to reach with hands and arms. Must be able to lift up to 15 pounds at times.

Work Authorization/Security Clearance

All offers of employment made by Tempus Unlimited are contingent upon satisfactory background check results. Pre-employment background checks will be conducted on all candidates that are offered a position at the agency in compliance with program policy as well as state and federal regulations. From time to time, these checks may be conducted on current employees to ensure compliance with all state and federal regulations and contracts.

EEO Statement

Equal Employment Opportunity is a fundamental principle at Tempus Unlimited, Inc. where employment from recruiting through the end of employment is based upon professional capabilities and qualifications without discrimination because of race, color, religion, sex, age, sexual orientation, veteran status, national origin, disability or any other characteristic as established by law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Other Duties

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.