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Staff Investigator more...
Location:Saint Louis, MO
Company:Express Scripts
First posted:August 24, 2017
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POSITION SUMMARY

Identify member and prescriber fraud and abuse risks using critical thinking skills and fraud analytics software. Complete complex investigational audits in order to correct risks identified and protect client assets, and present findings both verbally and in writing to key internal and external stakeholders. Identify and recommend policy and procedures and systems changes to enhance case development efficiency and quality of cases. Coordinate investigations with clients SIUs and MEDICs as necessary. Assist in mentoring and developing Program Integrity team members.

ESSENTIAL FUNCTIONS

  • Analyze and evaluate potential fraud and abuse situations using corroboratory information obtained by correspondence with members, physicians, and pharmacies.
  • Identify and investigate cases of suspected fraud and abuse for assigned clients. Develop these cases in compliance with any applicable policies, procedures, or regulatory requirements.
  • Prepare formal and thorough written reports to upper management, clients, and the Medicare Drug Integrity Contractors (MEDIC) expressing the findings of completed investigations.
  • Prepare for and take lead role in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed investigations, etc., for assigned clients.
  • Identify and perform special projects.
  • Mentor and develop Program Integrity team members.

QUALIFICATIONS

  • Bachelors degree or equivalent work experience
  • 2-5 years of relevant experience as a pharmacy technician, health care professional, or data analyst
  • Certified Pharmacy Technician, Certified Fraud Examiner, or similar certification strongly desired
  • Highly proficient in Microsoft Access & Excel, and data warehousing applications
  • Excellent organizational and interpersonal skills, critical thinking and planning skills, verbal and written communication skills, including ability to present to clients and internal stakeholders
  • Ability to work well with senior management and high level external contacts, handle sensitive or confidential information is critical, work with minimum management oversight on multiple projects with competing priorities
  • Ability to work a flexible schedule to accommodate project deadlines

ABOUT THE DEPARTMENT

Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of healthcare evolution. Team members are tasked with overseeing partnerships with Express Scripts key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 83+ million patients to have access to the medicine they need at a price they can afford.

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.

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