Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Medical Mutual’ s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Financial Investigator

Participates in the data and fact gathering activities which encompass the vigorous pursuit of criminal fraud and prevent future fraudulent payments. Supports investigative activities (external and internal) of the Company’s claims payment operations, providers of service, subscribers and employees.

Sr. Financial Investigator

Pursues criminal fraud and prevents future fraudulent payments. Investigates allegations of unlawful activity directed at corporate assets and continually maintains surveillance and investigative activities (external and internal) of the Company’s claims payment operations to providers of service, subscribers and employees.

Responsibilities

Financial Investigator

• Analyzes data to compile documentation of fraudulent behaviors.
• Examines claims information and identifies those with fraudulent billing patterns.
• Communicates with other departments to ensure consistency with policy and procedures.
• Performs other duties as assigned.

Sr. Financial Investigator

• Examines claims information and identifies those with fraudulent billing patterns. Initiates and conducts an investigation via research, medical record audit, reporting etc.
• Analyzes data to compile documentation of fraudulent behaviors.
• Analyzes and develops software programs/systems to monitor investigative process.
• Communicates with other departments to ensure consistency with policy and procedures.
• Performs other duties as assigned.

Qualifications

Financial Investigator

Education and Experience:

• Bachelor’s Degree in Criminal Justice, Business Administration or related field or an equivalent combination of education and experience.
• 3 years experience as a Financial Investigations Specialist or equivalent experience in fraud review in the health insurance industry.

Professional Certification(s):

• Accredited Health Care Fraud Investigator preferred.
• Health Care Anti-Fraud Associate preferred.
• Certified Fraud Examiner preferred.
• Certified Professional Coder preferred.

Technical Skills and Knowledge:

• Intermediate Lexis Nexus, VIPS software, DB-2, claims database, and Microsoft Office skills.
• Ability to perform rudimentary mathematical functions/calculations i.e.: addition, subtraction, percentages, fractions.
• Knowledge of medical terminology and coding.

Sr. Financial Investigator

Education and Experience:

• Bachelor’s Degree in Criminal Justice, Business Administration or related field or an equivalent combination of education and experience.
• 5 years’ experience as a Financial Investigator or equivalent progressive fraud investigation experience in the health insurance industry.

Professional Certification(s):

• Certified Fraud Examiner preferred.
• Accredited Health Care Fraud Investigator preferred.
• Certified Professional Coder preferred.
• Health Care Anti-Fraud Associate preferred.

Technical Skills and Knowledge:

• Intermediate to advanced Lexis Nexus, Clear, VIPS software, DB-2, claims database, and Microsoft Office skills.
• Knowledge of medical terminology and coding.

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Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.