Senior Investigator

5-10 yrs required

Full-time

No

Salary Information:

Competitive salary and benefits package offered
Salary range: $85,000-$120,000, depending on experience and qualifications
Bonus potential based on performance

Job Title: Senior Investigator (Investigator Sr)

Experience Information:

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.
Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting.
Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred.
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

Summary:

Elevance Health is seeking a Senior Investigator (Investigator Sr) to join their team. The ideal candidate will have a minimum of 5 years of experience in healthcare insurance and healthcare insurance investigation, with a strong understanding of health insurance policies, claims handling, and provider network contracting. This position offers a competitive salary and benefits package, with a salary range of $85,000-$120,000 depending on experience and qualifications. Bonus potential is also available based on performance.

As a member of the Elevance Health family of companies, Carelon Payment Integrity is dedicated to recovering, eliminating, and preventing unnecessary medical expense spending. The Senior Investigator will play a critical role in this mission by independently identifying, investigating, and developing complex cases against perpetrators of healthcare fraud.

The position will work in a hybrid model, with a mix of remote and in-office work. The ideal candidate will live within 50 miles of one of Elevance Health's PulsePoint locations. The company values personal and professional growth and offers a range of total rewards, including merit increases, paid holidays, paid time off, and incentive bonus programs. Medical, dental, vision, and disability benefits are also included, along with a 401(k) match, stock purchase plan, life insurance, and wellness programs.

The Senior Investigator's main responsibilities include conducting claim reviews, identifying and developing healthcare investigations, and collaborating with internal and external entities. The candidate should have a strong understanding of health insurance policies and procedures, as well as experience in negotiation and working with law enforcement and regulatory agencies.

The ideal candidate will have a BA/BS and at least 5 years of related experience, or a combination of education and experience that provides an equivalent background. Proficiency in Microsoft Excel is strongly preferred, and professional certifications such as CFE, AHFI, CPC, Paralegal, RN, or JD are a plus.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. The company also prioritizes the health and safety of its associates and communities and requires new candidates in certain patient/member-facing roles to be vaccinated against COVID-19.

Not applicable

Medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, financial education resources

English

Claim review, coding, data mining, entity review, law enforcement referral, data analysis, risk assessment, negotiation, policy development, legal proceedings, Microsoft Excel, professional certification, benefit programs management, research, rapport building, teamwork, leadership, decision-making, communication, problem-solving

Bachelor's degree in relevant field

Submit resume and cover letter to

Qualification and Experience Bachelor's degree in relevant field, minimum 5 years of experience in healthcare insurance and healthcare insurance investigation, law enforcement experience preferred

Legal