JOB DESCRIPTION

The SIU (Special Investigative Unit) Associate I will assist the Compliance and SIU Manager and SIU Team in the execution and maintenance of the Navitus fraud, abuse and waste program, controls, and associated policies and procedures. The SIU Associate I will initiate case files, gather necessary preliminary data to provide to SIU Investigators and make recommendations for next steps on a case referral.

Assist Compliance and SIU Manager and SIU Team with the execution and maintenance of the Navitus fraud and abuse program, controls and guidance.

Open SIU cases upon referral, assign a tracking number and initiate triage by gathering necessary data such as call notes, 3D reports, etc.

Assign to SIU Investigator for further action on case referrals based on data gathered, line of business and availability of Investigator.

Lead ID theft/stolen card investigations reported on members.

Conduct monthly reviews of the OIG / EPLS sanctions list and prepare necessary documentation of reviews.

Assist the SIU team with gathering of claims data and other FWA information for the completion and submission of client contractually required and management level reports on fraud detection activities in an accurate and timely basis.

Maintain work instructions associate with exclusion, FWA publication monitoring, and reporting responsibilities.

Assist in the development of fraud and compliance training for all new employees, annual re-training and ongoing training for existing employees including preparation of training materials, and tracking training activities.

Continuously research and identify latest fraud trends; regularly monitor media (publications, web sites, etc.) and prepare communications to keep employees aware of fraud issues and trends.

Actively participate in local, state and national organizations and events focused on fraud prevention and detection.

HIRING ORGANIZATION

At Navitus, we have the drive, passion, and vision to change pharmacy benefit management for the better. Thats what makes us leaders. However, its our expertise and experience in pharmacy benefits combined with our collaborative capability, flexibility and alignment to your goals that can help us be the partner that can make a difference. Navitus employees roughly 850 employees and has offices in multiple states. This position needs to be filled as it is an integral part of the prevention of fraud against prescription benefits. The execution and maintenance of the Navitus fraud, abuse and waste program, controls, and associated policies and procedures is an important facet.

Our Vision Statement is transforming the pharmacy experience to best serve all, and our mission statement is leading with integrity, we enhance peoples lives with a seamlessly connected pharmacy experience that improves health, lowers costs and eliminates complexity. From the beginning, weve challenged the status quo. Today we offer an independent and full disclosure business model to ensure complete alignment with our clients goals.

RECRUITING PLAN

Job posting-

Job Title: SIU Associate I

Summary:

The SIU Associate will execute and evaluate fraud and abuse of the prescription programs. The associate will start case files, do research, and find data and any other pertinent information for the SIU Investigators. The associate will also perform required reports and assist in communication with other staff.

Responsibilities:

Open SIU cases and assign a tracking number. Gather necessary data.

Assign cases to an investigator for further required investigation/action.

Conduct monthly reviews of sanction list and gather any documents that need to be sent for review.

Assist in compliance training and creation of workflows and SOPs.

Continually research latest fraud trends as well as media outlets for fraud issues and trends.

Participate in events focused on fraud detection and prevention.

Process state required fraud within the specified turnaround time.

Specifications/Requirements:

Bachelors degree

Pharmacy Tech Certification

Demonstrate willingness and skills to work towards fraud investigation certification.

At least one year experience in pharmacy or medical care setting.

Willingness to effectively communicate with other employees.

Ability to prioritize multiple tasks and make deadlines.

Communicates effectively and able to network with other departments.

Non-Electronic Recruiting-

We are going to offer additional incentives for employee referrals regarding this position. To get this hard to fill position filled, we will offer employee referrals additional monies on top of the already published incentives. With this, we hope that we will find a quality candidate for this position. Unfortunately, the cost of this recruitment technique will be higher than average with the increased incentive, however, I am confident it will produce a quality candidate.

There is a risk when using this type of technique, in which employees just refer a friend or someone they are an acquaintance to, to get this increased incentive. We could possibly have many applicants that are not qualified for the position and increased resumes that will need to be looked at.

CRM-

Using recruiting software to fill this position will also help us be consistent in hiring good matches and will be able to analyze applicants resumes and make more informed choices in a shorter time. Recruitment software will save us time, which is cost effective because we will not be going through resumes manually. Along with helping us recruit for the position, we will also be able to communicate will applicants on further steps if necessary. While this may be costly in the beginning, it will be advantageous in the search for the correct candidate by getting rid of lost time manually looking through applications and resumes. The average cost of using CRM per user depends on the functionality, but on average is $50-$150 per user.

EFFECTIVENESS OF RECRUITING PLAN

In measuring the effectiveness of our recruiting plan, quality of candidate and the time it takes to hire a candidate are the main metrics that we will use. Quality candidates who end up staying with the company long term will prove that the recruitment strategy is worthwhile. Also, someone who is qualified for the position is going to bring more to the team than someone who would be less qualified. We may be able to have less training and allocated resources with someone who is more qualified. They will be able to offer a different insight just coming into the company as well.

Also, the time it takes to fill a position, if we are using resources recruiting with no potential candidates or very few, this is not going to be worthwhile for the company. If we are allocating our resources to filling a position and it takes loner for us to fill that position, we are not being cost effective. Filling positions quickly and with qualified candidates is successful for our recruitment process.

SELECTION PLAN

Our selection plan will include cognitive ability and integrity tests. Cognitive ability tests assess abilities involved in thinking (e.g., reasoning, perception, memory, verbal and mathematical ability, and problem solving). Such tests pose questions designed to estimate candidates potential to use mental processes to solve work-related problems or to acquire new job knowledge. I chose this device because it is the single best (highest criterion validity) predictor of job performance. The potential negative effect on this selection device is Cognitive ability tests typically produce racial and ethnic differences larger than other valid predictors of job performance.

An integrity test is a specific type of personality test designed to assess an applicant's tendency to be honest, trustworthy, and dependable. Integrity tests can also be valid measures of overall job performance. Integrity tests have a minimal impact for faking answers. This will be implemented electronically, like the way a cognitive test will be. I chose this selection device because it will help predict counterproductive behaviors as well as predict general job performance and will have no adverse impact. Possible negative affect of this would be that the test may contain items that do not appear to be job related or seem to reveal applicant's private thoughts and feelings.

EFFECTIVENESS OF SELECTION PLAN

I would be assessing the effectiveness of my selection plan by the number of qualified candidates per hire and the cost per hire. A qualified candidate is anyone who passes the application screening process and moves to the next stages of the recruitment process. If there are multiple candidates that come in for an interview because they were considered qualified but dont meet the qualifications, this would be a failure. For this to be effective, the candidates all need to be qualified for the position. The other measurement to use is the cost per hire. There are many strategies to use to reduce the cost per hire and optimize recruitment such as building a talent pipeline, allowing employee referrals, and using social media to create a strong employer brand. Of course, we want qualified candidates, but we also want to keep our costs lower. Successful selection plans would allow us to still find quality but at a lower cost.

To decide whether the number of qualified candidates per hire is effective as a selection process we would divide the number of candidates picked for an interview by the number of candidates offered to the hiring manager. This would allow us to decide if this is an effective strategy. To measure the effectiveness of the cost per hire we would add all internal and external recruitment expenses and divide by the total number of recruits. Internal recruiting costs are all expenses associated with the recruitment department. The external recruitment costs comprise all the expenses related to external vendors and candidates such as advertising, job fairs, signing bonuses, etc.

Purpose of Project: Apply concepts and processes of performance management to create a performance evaluation system for the position you used in the Recruitment and Selection Project. Also, consider the nature of different performance management strategies.

Scenario: You have been asked to create a formal performance evaluation system for the job described in your Recruitment and Selection Project. Please include the following components, combining them into a professional document, like that which you would submit to the management in the organization.

Description of the organizations goals and values that could serve as the overall direction for division, department, and individual performance. You may use material you created for the Recruitment & Selection Project, #3. (1-2 paragraphs)

Copy of the job description for the position being evaluated. Use the same one you used in the Recruitment and Selection Project.

Formal Evaluation Form

Create an actual, uncompleted evaluation form that could be completed by a supervisor, peer, or subordinate. This will include things like job title, rating/ranking/descriptive scales or boxes. Make it look like a real form. Include the following:

Section for evaluating at least four Job Functions/Tasks relevant to the job you have described. Be sure to identify the functions/tasks and provide an appropriate rating mechanism.

Section for evaluating at least two goals that would fit the position given the specific organization. Be sure to list/define the goals and include an appropriate rating mechanism.

Section for future development goals. Provide a sample goal, along with instructions for the employee to identify their goals.

Places for supervisor and employee comments.

Please answer the following questions:

How might a self-appraisal be helpful in the performance management process? Briefly describe what areas/types of performance issues you would include in a self-appraisal created for the job used in this assignment.

Who (or which position) should complete the formal evaluation? Why did you select the individual in this position?