Liaison jobs at Hagerty

G.E.H.A (Government Employees Health Association, Inc.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees. G.E.H.A has one mission: To empower federal workers to be healthy and well. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. The Special Investigations (SIU)/Fraud, Waste, and Abuse (FWA) Liaison is primarily responsible for the oversight and monitoring of the SIU/FWA operations performed by a third-party vendor in conducting benefit integrity initiatives for GEHA pursuant to OPM contract requirements. The SIU/FWA Liaison will partner with a third-party vendor to provide guidance on knowledge of FWA schemes, coding guidelines, medical policies, investigative best practices, case management / documentation requirements, and financial tracking/reporting. This role will be responsible for reporting progress of SIU/FWA initiatives, maintaining a productive, positive working relationship with other business units within the organization and at the third-party, as well as making recommendations for improvements in processes. This role reports to the Vice President, Internal Audit and Special Investigations.SKILLS Duties and Responsibilities Oversee and monitor the activities of SIU/FWA functions performed by a third-party, including investigations and medical reviews pertaining to allegations of healthcare fraud, waste, and abuse. Provide guidance to a third-party in compliance with Office of Personnel Management (OPM) and OPM Office of Inspector General (OIG) requirements for investigations and referrals. Responsible for ensuring the third-party processes and training expectations under OPM and OPM-OIG requirements are met. Provide recommendations for updates necessary for the effective operation of the SIU/FWA function at the third-party, as required by OPM and OPM-OIG. Prepare and provide periodic progress updates of the third-parties activities to keep senior management informed of fraud prevention and detection efforts as well as compliance with OPM contract requirements. Serve as a liaison to the OIG on behalf of GEHA providing support for Case Notifications made by SIU and other requests by OIG. Serve as a liaison between the third-party and Pharmacy Benefit Manager. Support legal proceedings related to SIU investigations, including testifying in court, and/or collaborating with law enforcement to prepare cases for civil or criminal actions. Ensure quality and accuracy of investigations and other activities performed by third-party SIU/FWA personnel by reviewing periodic reports prepared by third-party; recommend further actions based on results. Stay up to date on emerging fraud trends and industry best practices by building relationships with other health plan SIUs and law enforcement representatives. Provide healthcare fraud, waste, and abuse training, as appropriate, across GEHA and to the third-party. Monitor, validate, and timely report on key metrics pursuant to OPM requirements related to allegations of fraud, waste, and abuse as well as all financial reporting requirements. Prepare all necessary regulatory reports, ensuring appropriate case notifications / referrals are made in accordance with OPM and OPM-OIG guidance. Lead by example in performing duties, maintaining confidentiality and discretion in all investigative activity. Crosstrain on other payment integrity functions as requested. Perform special projects and other duties as assigned. Required Qualifications Bachelor's Degree in a related field or discipline. Master's degree preferred. Minimum of five (5) years of experience leading people, either through direct or indirect roles, with a demonstrated ability to build relationships with internal and external partners, influencing and driving accountability in a positive and productive manner. Eight (8) years of healthcare investigations experience within a health plan SIU environment Preferred qualifications: Accredited Healthcare Fraud Investigator (AHFI) Certification, Certified Professional Coder (CPC), and/or Certified Fraud Examiner (CFE) Knowledge and Skills Exceptional communication and decision-making skills with the ability to prioritize workload, manage multiple initiatives and take appropriate action without direction. Strong management and dynamic leadership skills with the ability to proactively identify areas of risk to the organization related to FWA. Strong negotiation and mediation skills, as well as vendor management capabilities. Deep knowledge of SIU and investigative processes and ability to suggest process improvements that increase efficiency and productivity. Knowledge of medical and dental terminology CDT, CPT, HCPCS and ICD codes Strong proficiency in the use of software applications used for data analysis, investigation, and SIU management. Willingness to travel to meet with law enforcement, attend conferences and other industry related workgroups. OR Any combination of education, professional training, or work experience, which demonstrates the ability to perform the duties of the position. Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match - dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The hiring range for this position is $97,110 - $122,850 USD. At G.E.H.A, the current maximum salary for this role is $136,890 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization. G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.