Senior Investigator

Min 5 yrs required

Full-time

No

Salary Information:

The salary for this position ranges from $80,000 to $120,000 per year, depending on experience and qualifications.

Job Title: Senior Investigator (Investigator Sr)

Experience Information:

Requires a BA/BS and minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Responsibilities:

- Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims
- Independently identify and develop enterprise-wide specific healthcare investigations and initiatives
- Interface with senior level management and legal department throughout investigative process
- Assist in training of internal and external entities
- Develop and maintain rapport with law enforcement and regulatory agencies
- Represent the company in court proceedings regarding research findings
- Assist in the development of policies and procedures to prevent loss of company assets
- Utilize Microsoft Excel and its functionality
- Obtain professional certification (CFE, AHFI, CPC, Paralegal, RN, JD)
- Knowledge of health insurance policies, claims handling, and provider network contracting

Requirements:

- BA/BS degree
- Minimum 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement, or a combination of education and experience
- Health insurance experience
- Understanding of health insurance policies, claims handling, and provider network contracting
- Proficiency in Microsoft Excel
- Professional certification preferred
- Knowledge of plan policies and procedures in all facets of benefit programs management
- Negotiation skills
- Strong communication and interpersonal skills

About the Company:

Elevance Health is a health company dedicated to improving lives and communities through simplified healthcare. As a Fortune 25 company, Elevance Health has a longstanding history in the healthcare industry and is looking for passionate leaders at all levels of the organization. With a focus on personal and professional growth, Elevance Health offers a range of competitive benefits and operates in a hybrid workforce strategy.

Location:

This position is a hybrid model, with the ideal candidate living within 50 miles of one of Elevance Health's PulsePoint locations.

Responsibilities:

- Conduct claim reviews
- Independently identify and develop healthcare investigations and initiatives
- Interface with senior level management and legal department
- Train internal and external entities
- Develop and maintain rapport with law enforcement and regulatory agencies
- Represent the company in court proceedings
- Assist in developing policies and procedures
- Utilize Microsoft Excel
- Obtain professional certification
- Knowledge of health insurance and benefit programs management
- Negotiation skills


Requirements:

- BA/BS degree
- Minimum 5 years related experience
- Health insurance experience
- Understanding of health insurance policies, claims handling, and provider network contracting
- Proficiency in Microsoft Excel
- Professional certification preferred
- Knowledge of plan policies and procedures
- Negotiation skills
- Strong communication and interpersonal skills

Salary Information:

The salary for this position ranges from $80,000 to $120,000 per year, depending on experience and qualifications.

Experience Information:

Requires a BA/BS and minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Location:

This position is a hybrid model, with the ideal candidate living within 50 miles of one of Elevance Health's PulsePoint locations in Indiana, Maryland, Ohio, Rhode Island, Florida, New Jersey, Virginia, Illinois, and Georgia.

H1 and H2 Headings:

H1: Senior Investigator (Investigator Sr)
H2: Job Description

H1: Responsibilities
H2: Conduct Claim Reviews
H2: Independently Identify and Develop Healthcare Investigations
H2: Interface with Senior Level Management and Legal Department
H2: Train Internal and External Entities
H2: Develop and Maintain Rapport with Law Enforcement and Regulatory Agencies
H2: Represent the Company in Court Proceedings
H2: Assist in Developing Policies and Procedures
H2: Utilize Microsoft Excel
H2: Obtain Professional Certification
H2: Knowledge of Health Insurance and Benefit Programs Management
H2: Negotiation Skills

H1: Requirements
H2: Education and Experience
H2: Health Insurance Experience
H2: Understanding of Health Insurance Policies, Claims Handling, and Provider Network Contracting
H2: Proficiency in Microsoft Excel
H2: Professional Certification
H2: Knowledge of Plan Policies and Procedures
H2: Negotiation Skills
H2: Strong Communication and Interpersonal Skills

H1: About the Company
H2: Mission and Values
H2: Culture and Workforce Strategy
H2: Competitive Benefits

H1: Location
H2: Hybrid Model
H2: Ideal Candidate Location

H1: Salary Information
H2: Range and Factors Affecting Salary

H1: Experience Information
H2: Education and Experience Requirements

Bullet Points:

- Conduct claim reviews
- Independently identify and develop healthcare investigations
- Interface with senior level management and legal department
- Train internal and external entities
- Develop and maintain rapport with law enforcement and regulatory agencies
- Represent the company in court proceedings
- Assist in developing policies and procedures
- Utilize Microsoft Excel
- Obtain professional certification
- Knowledge of health insurance and benefit programs management
- Negotiation skills
- Strong communication and interpersonal skills
- Hybrid model with ideal candidate living within 50 miles of Elevance Health's PulsePoint locations
- Fortune 25 company with a focus on personal and professional growth
- Competitive benefits package
- Salary range of $80,000 to $120,000 per year
- Minimum 5 years related experience required
- Health insurance experience preferred
- Must reside within 50

Not specified

Merit increases, Paid holidays, PTO, Incentive bonus programs, Medical benefits, Dental benefits, Vision benefits, Short-term disability, Long-term disability, 401(k) matching, Stock purchase plan, Life insurance, Wellness programs, Financial education

Not specified

Claim reviews, Coding, Data mining, Entity review, Law enforcement referral, Proprietary data analysis, Claim system review, Policy development, Procedure development, Court representation, Microsoft Excel, CFE, AHFI, CPC, Paralegal, RN, JD, Plan policies and procedures, Benefit programs management, Negotiation, Rapport building, Cooperation, Regulatory agencies, Healthcare industry knowledge, Strategy implementation, Leadership, Personal and professional growth, Values and behaviors, Total rewards, Merit increases, Paid holidays, PTO, Incentive bonus programs, Medical benefits, Dental benefits, Vision benefits, Short-term disability, Long-term disability, 401(k) matching, Stock purchase plan, Life insurance, Wellness programs, Financial education, Hybrid workforce, COVID-19 vaccination policy, Equal employment opportunity

BA/BS in related field

Interested candidates should submit their resume to

Qualification and Experience BA/BS in related field, 5 years experience in healthcare insurance and investigation, or equivalent combination of education and experience

Legal