Fraud Prevention Supervisor supervises fraud detection associates in their effort to identify and prevent future fraud. Leads cross-functional initiatives to proactively detect and prevent fraud from occurring. Being a Fraud Prevention Supervisor regularly reviews the team's work product and makes recommendations as needed. Researches, documents, and implements best practices in the fraud prevention industry. Additionally, Fraud Prevention Supervisor analyzes current processes and procedures and makes recommendations to promote more effective operations. Provides training and guidance to new employees. Typically requires a bachelor's degree. Typically reports to a manager. The Fraud Prevention Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. To be a Fraud Prevention Supervisor typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision. (Copyright 2024 Salary.com)
-Daily review of Electronic Visit Verification (EW) entries in LaSRS to ensure the entries are consistent with acceptable home or community locations. This includes review of GPS coordinates to verify locations.
-Identification of suspect entries
-Review of supporting documentation for suspect entries
-Communication with workers to obtain explanations for suspect entries and reminders of EW requirements
-Documentation of conversations with workers regarding suspect entries
-Preparing investigation reports
-Weekly analytical and performance reports
-Electronic scanning of documents as needed
-Deal effectively with consumers, employees and the general public as needed
-Perform other similar or related duties as assigned
-Cooperation with other law enforcement or other governing entities pursuant to substantiated cases.
Requirements:
-High School Diploma
-PC proficiency
-Advanced skills in MS Word, Excel, and a working knowledge of MS Access.
-Typing minimum of 50 wpm.
-Maintaining confidentiality and discretion in the course of conducting business Ability to multi-task
- A minimum of 3 years' experience in a similar environment (high education may be substituted for this requirement)
-Demonstrate tact, above average communication skills, ability to work effectively with co-workers and managers.
The Fraud Control Clerk is a member of the Administrative Department of AHS. The Fraud Control Clerk will monitor Medicaid and other insurance claims to identify and investigate suspected fraud. Position will lead, participate in, or assist with collection and storage of evidence (to include electronic data and evidence) for substantiated and unsubstantiated fraud.
Job Type: Full-time
Pay: From $15.00 per hour
Expected hours: 36 – 40 per week
Benefits:
Schedule:
Experience:
Work Location: In person
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