Fraud Detection_Fraud Executive Advisor

This is a remote position and a part-time position (15 hours per month)
Must be a US Citizen or Permanent Resident.

Statement of Work:
The client is delivering a NexGen Program Integrity Solution where we will be using the client tool, FAMS (Fraud and Abuse Management System), to perform fraud detection on Defense Health Agency (DHA) active duty medical claims for both pre-payment, known as in-line fraud detection, and post-payment, known as retrospective fraud detection. We will also be integrating this fraud detection tool with the ATOM platform, to provide a case management solution that enables fraud analysists to disposition alerts and conduct investigations on flagged claims as required.

Task Description:
The TriWest Fraud Detection services Fraud Executive Advisor will support the Fraud and Abuse Management System (FAMS) Team as they deploy FAMS to detection fraud on claims within the T5 contract.

Required skills/Level of Experience :
• Experience leading Fraud and Abuse Management System (FAMS) Tool implementations
• Experience working on the TriWest T5 Fraud Detection Services Contract
• Experience and relationships with TriWest C-Suite leadership
• Experience with Defense Health Agency fraud detection and VA Community Care Network (CCN) fraud detection
• Experience with healthcare fraud detection
• 20+ year of experience in FWA detection
Nice to have skills:
• Familiarity with Appian
• Experience with Public Sector Clients (US Federal, Higher Education, State and Local Governments)

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