Claims Fraud and Abuse Specialist Position Available In Hillsborough, Florida

Claims Fraud and Abuse Specialist 3.8 3.8 out of 5 stars Tampa, FL 33634 Wipro Limited (

NYSE:

WIT, BSE

507685,

NSE:

WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com. Job Description A Fraud, Waste and Abuse (FWA) Specialist investigates and analyzes potential FWA schemes ensuring compliance with regulations and policies and recommending corrective actions. They may be involved in identifying, validating and recovering overpayments as well as researching and developing new FWA job aides.

ESSENTIAL JOB FUNCTIONS/DUTIES

Investigation and Analysis:

Conducting thorough investigations of suspected FWA cases, analyzing data and identifying patterns.

Compliance:

Ensuring adherence to relevant FWA laws, regulations and policies.

Data Analysis:

Interpreting and analyzing data to identify trends, opportunities and potential FWA schemes.

Reporting:

Preparing reports on FWA investigations, findings and recommendations.

Training and Education:

Developing and delivering training programs on FWA prevention and identification

Collaboration:

Working with internal and external stakeholders, including auditors, investigators and legal professionals.

Quality Assurance:

Ensuring the accuracy and integrity of data and processes related to FWA. Review of all foreign claims for legitimacy and currency conversion. Follow all HIPAA guidelines for the release of information Coordinate escalations with medical review and follow-up timely to assure timeframes and client expectations are met Interpret Summary Plan Document language Work with the Appeals Team to assist with medical review activities when time permits Other duties as assigned

QUALIFICATION REQUIREMENTS

High School/GED required. Nursing degree preferred. Demonstrate skills in problem solving and benefit plan interpretation Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus 2 years’ experience in Medical Review/FWA review. Ability to work independently PC proficiency Average typing ability

EDUCATION REQUIREMENTS

High School Diploma required, Associates degree preferred

PHYSICAL REQUIREMENTS

Working conditions are normal for an office environment. May be subject to interruptions. Minimal physical exertion. Required to work on a computer. Expected annual pay for this role ranges from to . Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA – as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Come to Wipro. Realize your ambitions. Applications from people with disabilities are explicitly welcome.