Required Qualifications:  High school diploma, GED, or equivalent work experience 5+ years of experience in the health insurance industry: in auditing, claims processing, payment integrity, claims configuration 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity 2+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc