Job Description
We’re looking for a detail-oriented, analytical **LTC Fraud Consultant** to help strengthen our Long-Term Care (LTC) Fraud, Waste & Abuse (FWA) program. In this role, you’ll turn claims and operational data into insights that support investigations, surface emerging fraud trends, and improve processes and controls across the program.
**Position Responsibilities:**
+ Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
+ Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support.
+ Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
+ Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
+ Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process impr...
**Position Responsibilities:**
+ Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
+ Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support.
+ Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
+ Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
+ Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process impr...