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Fraud and Abuse Specialist

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POST DATE 9/10/2016
END DATE 9/14/2017

Logisticare Saint Louis, MO

Saint Louis, MO
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED


- Qualified candidates must have a high school degree or GED

- Prior front office medical experience, medical case management, and/or medical social work experience a plus

- Must possess professional writiting skills and ability to correspond with professionals both verbally and in writing.

- Strong verbal communications, problem solving, time management and organizational skills

- Ability to accurately type 35 corrected words per minute, and ability to work independently or with a team a must

- Must have strong spreadsheet and database skills as well as excellent attention to detail

- Proficient in Microsoft Word, Excel; proficient in Access a plus

- Communication, Oral - Ability to communicate effectively with others using the spoken word

- Communication, Written - Ability to communicate in writing clearly and concisely

- Organized - Possessing the trait of being organized or following a systematic method of performing a task

- Problem Solving - Ability to find a solution for or to deal proactively with work-related problems

- Time Management - Ability to utilize the available time to organize and complete work within given deadlines

Environmental and Working Conditions:
- Entire work time is conducted in an office setting

Physical and Mental Requirements:
- Must be able to understand and follow complex instructions

- Ability to work independently or with a team a must

Job Description:
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare s client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.
LogistiCare seeks a full-time Fraud and Abuse Specialist. The Fraud and Abuse (F&A) Specialist identifies utilization and billing trends that may signal abusive practices by performing the following duties:

- Reviews a variety of utilization and billing records to identify unusual or suspicious patterns of utilization and billing

- Investigates all issues to confirm the actual utilization

- Reports to senior management the need to address abusive or fraudulent situations

- Performs other duties as assigned

Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.

LogistiCare is an Affirmative Action-Equal Opportunity Employer.