• Use pharmacy hospital clinical knowledge to perform detail review and analysis of pharmacy dispense, verification, administration documentation, waste documentation and coding to ensure pharmacy billing compliance standards are met. • Verify medication dosing unit of measure calculation based on specific National Drug Code (NDC) and for units administered to the patients. • Ensure current up to date pricing by validating Epic applied pricing is consistent with external source, when inconsistency exist use experience and judgement to propose resolution. • Review Healthcare Common Procedure Coding Systems (HCPCS) coding and Medicare billing quantity are appropriate to ensure maximize reimbursement and prevent payer denial. • Analyze and validate accuracy of JW Waste Modifier documentation and perform manual calculation and charge when necessary. • Trouble shoot; problem solve, communicate and collaborate deficiency. • Maintain multiple follow-ups and work towards resolution with Nursing, Providers and Pharmacy Operations on deficiency to support billing compliance. • Review false positive reports for deficiency and identify trends, resolve issues and plan remediation plan as necessary. • Analyze and interpret paper medication documentations for non-Epic system charge and perform manual charge capture aka bulk charging in Epic Willow. • Provide technical support in the design, implementation and ongoing monitoring of pharmaceutical charges across multiple pharmacy systems. • Ensure pharmacy charge methods are in compliance with regulatory requirements. • Work to continuously evaluate pharmacy systems that are used for charge capture and supporting documentation. • Use the Omnicell Automated Dispense Cabinet report to assess medication utilization by hospital units. • Utilize Workflow Rx system to remotely access Omnicell Carousel Medication Cabinet in order to view inventory and pharmacy dispense tracking. • Run EPIC workbench, Omni center Firefox, Bobj reports to review details.

Role Description The Fraud Analyst works in support of the EMPLOYERS' Special Investigations program goal to both protect EMPLOYERS against the adverse financial impact of workers' compensation fraud and to ensure compliance with federal, state, and local anti-fraud statutory/regulatory mandates. The Fraud Analyst provides essential administrative and analytical support to the SIU team by performing data research, maintaining investigation records, preparing reports, and identifying patterns or anomalies in claims data that may indicate fraudulent activity. - Provides administrative and operational support to the SIU team, including maintaining case files, tracking deadlines, and coordinating case-related documentation. - Conducts basic data research and analysis using internal systems, industry databases, and public records to support active investigations. - Completes social media, industry-related database, and other public information searches as directed by SIU Leadership. - Assists in the identification of potential fraud red flags by reviewing claims data and flagging anomalies for investigator review. - Collects, organizes, and maintains investigation-related records, evidence logs, and supporting documentation. - Prepares written summaries, data reports, and analytical findings for use by SIU investigators and management. - Identifies and utilizes the most cost-effective database and research tools available. - Complies with local, state, and federal regulations involved with accessing, retrieval, and storage of public and database-available information. - Adopts new processes, technologies, and workflow changes with a positive and proactive mindset. - Continuously monitors own workload quality, seeking clarification or training when necessary to improve outcomes and consistency. - Exercises due diligence at all times to protect EMPLOYERS against any unnecessary risks associated with the investigatory process. - Assists with the preparation of periodic and ad-hoc production reports for SIU management. - Participates in SIU associations, seminars, and training opportunities to maintain current knowledge of fraud trends and investigative tools. - Other duties may be assigned. Qualifications - Associate’s degree or equivalent combination of training/experience preferred. - Minimum of 1 year of combined experience from any of the following areas: - Workers’ Compensation Insurance fraud investigations - Governmental insurance oversight - Property and Casualty Claims - Property and Casualty Premium Audit - Law enforcement - Loss Control - Knowledge of Workers’ Compensation claims processes and regulations preferred. - Possess strong analytical, tracking, and monitoring skills with attention to detail. - Ability to effectively communicate in a collaborative environment, using various technology tools. - Possess strong oral and written communication, listening, interpersonal, customer service, and telephone skills. - Must be self-motivated with the ability to work independently and within a team environment. - Possess the ability to multi-task, identify the importance of each task and issue, adhere to deadlines, and complete assignments accordingly. - Excellent problem-solving and decision-making skills and the ability to remain professional in all situations. - Ability to maintain confidentiality. - Computer skills (MS Office, Internet searches, industry database familiarity, etc.). - Valid state driver’s license and good driving record. Requirements - Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship. - It requires a suitable space that provides a private and quiet workplace. - Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. - Travel: May be required to travel to off-site location(s) to attend meetings, as necessary. Benefits - Hourly Pay Range: $23.00 - $32.00 per hour. - A comprehensive benefits package, please follow the link to our benefits page for details!

Role Description The SIU Investigator works in support of the EMPLOYERS’ Special Investigation Program goal to both protect EMPLOYERS against the adverse financial impact of workers’ compensation fraud and to ensure compliance with federal, state, and local anti-fraud statutory/regulatory mandates. The SIU Investigator conducts suspected insurance fraud investigations as related to claimants, policyholders, agents and/or providers who are suspected of having committed workers’ compensation fraud against EMPLOYERS, its member companies and its policyholders. - Reviews and evaluates incoming referrals of suspected workers’ compensation fraud for potential submission to appropriate law enforcement/prosecutorial agencies for criminal investigation and prosecution. - Provides support to cross-departmental personnel in evaluating and identifying red flags and provides recommendations and guidance. - Coordinates with internal staff, vendor attorneys and investigative vendors on specific investigative steps to follow upon receipt of investigative findings. - Collects, reviews, analyzes, evaluates, and organizes related/associated evidence, including medical records, depositions, witness statements, computer records, financial records, business records, related investigative reports, subrosa video, police reports, etc. - Identifies, locates, and interviews potential witnesses, assessing their credibility for use as witnesses in court proceedings for criminal, civil and administrative actions. - Accesses electronic databases to obtain public/industry information to assist in the development of evidence in Workers’ Compensation fraud cases. - Prepares detailed, written investigation reports to include an investigative synopsis; as applicable, a list of applicable statutes violated, a list (and copies) of all evidence items gathered during the investigation process and a list of all witnesses, their contact information and a description of the elements of the case to which they can testify. - Adopts new processes, technologies, and workflow changes with a positive and proactive mindset, serving as an early adopter who helps identify potential challenges and communicates frontline feedback. - Continuously monitors own workload quality, seeking clarification or training when necessary to improve outcomes and consistency. - Submits suspected fraud referrals to the appropriate state/local law enforcement/prosecutorial agencies pursuant to state specific statutory guidelines/requirements, utilizing the specific required state-mandated format. - Provides follow-up support as required after submitting a case of suspected Workers’ Compensation fraud to the appropriate state/local law enforcement/prosecutorial agencies (follow-up investigation, witness coordination, etc.). - Testifies in court as required. - Travels on short notice to various local or out of state destinations to perform investigative duties, appear in court, meet with law enforcement/prosecutorial personnel, or to provide or obtain training. - Assists Claims personnel in their administrative efforts based on relevant findings of an SIU investigation. - Participates in anti-fraud training to EMPLOYERS’ personnel, policyholders, producers, network medical providers and defense legal counsel. - Assists law enforcement and prosecutorial agencies in their anti-fraud efforts, including participation in law enforcement taskforces and advisory groups. - Exercises due diligence at all times to protect EMPLOYERS against any unnecessary risks associated with the investigatory process. - Assists in maximizing media interest in the positive aspects of the EMPLOYERS’ anti-fraud program in support of the EMPLOYERS Sales and Marketing efforts. - Other duties may be assigned. Qualifications - Minimum of 2-3 years of combined experience from any of the following areas: - Workers’ Compensation Insurance fraud investigations - Governmental insurance oversight - Property and Casualty Claims - Property and Casualty Premium Audit - Law enforcement - Loss Control - Knowledge of Workers’ Compensation claims processes and regulations, with CA Workers’ Compensation knowledge preferred. - Valid state driver’s license and good driving record. - Working knowledge of federal, state and local statutes, ordinances, regulations and case law pertaining to insurance fraud (preferably Workers’ Compensation insurance fraud) and of the criminal justice judicial system. - Superior oral and written communication, listening, interpersonal, customer service and telephone skills. - Must be self-motivated with the ability to work independently with minimal direction and possess the abilities and skills to multi-task, to determine the relative importance of each task and issue, to adhere to deadlines, and to complete assignments accordingly. - Excellent analytical, problem solving and decision-making skills and the ability to deal professionally with people in stressful situations. - Ability to maintain confidentiality. - Computer skills (MS Office, Internet searches, Industry database familiarity, etc.) Requirements - Bachelor's degree or equivalent combination of training/experience required. Benefits - Salary Range: $60,000 - $90,000 - Comprehensive benefits package. Company Description As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! - We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! - Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. - EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. - We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. - At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement.

Role Description Our client is seeking experienced Epic Cupid Analysts to support an expansion project. This analyst will contribute to build, testing, readiness, and Go-Live efforts, partnering closely with clinical, operational, and technical teams to ensure a smooth implementation and transition to steady state. We are seeking highly skilled Epic professionals who can operate effectively in a primarily remote capacity while being available onsite for essential Go-Live support. Key Responsibilities - Epic Build & Configuration - Complete additional Cupid and Radiant build to support project scope, operational needs, and readiness milestones. - Configure workflows, rules, order sets, imaging protocols, and integrated system components. - Collaborate with clinical and operational stakeholders to ensure alignment with end-user requirements. - Testing & Validation - Support integrated testing, end-user testing, and environment validation. - Troubleshoot and document issues identified during testing, making appropriate updates to build. - Ensure testing workflows, scenarios, and results are accurately recorded. - Go-Live Readiness & Support - Participate in deployment planning and Go-Live readiness activities. - Provide in-person onsite support as needed during Go-Live, including workflow assistance, issue triage, and rapid problem resolution. - Deliver post–Go-Live support to stabilize operations and facilitate a smooth transition to steady state. Qualifications - Epic certification in Cupid or Radiant is required. - Minimum of 3 years of experience supporting Epic build, testing, and Go-Live activities. - Strong understanding of Radiology, Cardiology, or associated procedural workflows. - Demonstrated experience collaborating with technical, clinical, and operational teams. - Excellent communication, problem-solving, and customer service skills. - Experience in multi-site or large healthcare system implementations preferred. Requirements - Prior Epic consulting experience. - Ability to function independently in a remote environment while maintaining high engagement with stakeholders. - Strong organizational skills and attention to detail. - Flexibility to support onsite needs during Go-Live and critical phases. Benefits - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Company Description TEKsystems is a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution, and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe, and Asia, who partner with us for our scale, full-stack capabilities, and speed.