Legal Staff Paralegal in Woburn, MA

In-House

Woburn, MA

Legal Staff Paralegal in Woburn, MA

Legal Staff

Min 5 yrs required

No

Job Title: Investigator Senior

Job Responsibilities:
The Investigator Senior is tasked with the independent identification, investigation, and development of complex cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. This position requires a thorough review of claims for appropriate coding, data mining, entity review, and referrals to law enforcement, utilizing proprietary data and claim systems for the review of facility, professional, and pharmacy claims. The role involves independently identifying and developing specific healthcare investigations and initiatives that may impact more than one health plan, line of business, or state. The Investigator Senior may interface internally with senior-level management and the legal department throughout the investigative process and may assist in training internal and external entities. The role also includes assisting in the development of policies and procedures to prevent the loss of company assets and potentially representing the company in court proceedings regarding research findings. Establishing and maintaining rapport with federal, state, and local law enforcement and regulatory agencies is crucial to assist in investigative efforts.

Education and Experience Information:
The position requires a BA/BS degree and a minimum of five years of related experience in healthcare insurance and healthcare insurance investigation, or law enforcement. Alternatively, a combination of education and experience that provides an equivalent background is acceptable. Professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designations are preferred. Candidates should have knowledge of plan policies and procedures in all facets of benefit programs management, with a strong emphasis on negotiation.

Salary Information:
For candidates working in specific locations such as California, Colorado, District of Columbia, Maryland, Minnesota, New York, and Washington State, the salary range for this position is $82,320 to $141,120. In addition to salary, **Members Only** offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. The salary offered is based on various legitimate, non-discriminatory factors set by the company and is subject to eligibility requirements. **Members Only** is committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range reflects the range of possible compensation for this role at the time of posting and may be modified in the future. Actual compensation may vary based on geographic location, work experience, education, skill level, and market/business considerations.

Company Overview:
**Members Only** is a health company dedicated to improving lives and communities and simplifying healthcare. It is a Fortune 25 company with a longstanding history in the healthcare industry, seeking leaders passionate about making an impact on members and communities. **Members Only** is creating a culture designed to advance its strategy and promote personal and professional growth for associates. The company offers market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Work Environment:
**Members Only** operates under a Hybrid Workforce Strategy, requiring associates to work at an **Members Only** location at least once per week unless specified as primarily virtual. Specific onsite requirements will be discussed during the hiring process. The health of associates and communities is a top priority, and new candidates in certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza unless an acceptable explanation is provided.

Equal Employment Opportunity:
**Members Only** is an Equal Employment Opportunity employer, considering all qualified applicants for employment without regard to various protected statuses. Applicants requiring accommodation for the job application process may contact the company for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all relevant laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.