Senior Investigator

Min 5 yrs required

Full-time

No

SEO Friendly Job Title: Senior Investigator - Healthcare Fraud

H1: Join Elevance Health as a Senior Investigator and make an impact on healthcare fraud

H2: Investigate Complex Cases and Recover Corporate Funds with Elevance Health

Bold Headlines:
- Independent Identification and Investigation of Healthcare Fraud Cases
- Develop Complex Investigations to Impact Multiple Companies
- Interface with Senior Management and Legal Team
- Establish Rapport with Law Enforcement and Regulatory Agencies
- Preferred Skills: Pharmacy Investigation Experience and Professional Certification
- Salary Range: $73,360 to $132,048
- Benefits: Comprehensive Benefits Package, Incentive and Recognition Programs, Equity Stock Purchase and 401k Contribution
- Equal Pay Opportunities Regardless of Gender, Race, or Other Protected Category
- Hybrid Workforce Strategy with Onsite Requirements
- Vaccination Required for Certain Patient/Member-Facing Roles
- Equal Employment Opportunity Employer with Accommodation Options

Elevance Health, a Fortune 25 healthcare company, is seeking a Senior Investigator to join their team and make an impact on healthcare fraud. This full-time position requires 1-2 days per week in the office and is open to candidates living within 50 miles of one of Elevance Health's locations. As a Senior Investigator, you will be responsible for identifying, investigating, and developing complex cases against perpetrators of healthcare fraud to recover corporate and client funds.

Key Responsibilities:
- Conduct claim reviews and utilize data and claim systems to identify fraudulent claims
- Develop enterprise-wide investigations and initiatives that may impact multiple companies
- Interface with senior management and legal team throughout the investigative process
- Assist in training internal and external entities
- Develop policies and procedures to prevent loss of company assets
- Represent the company in court proceedings regarding research findings
- Establish and maintain rapport with law enforcement and regulatory agencies
- Understand health insurance policies, claims handling, and provider network contracting
- Collaborate with federal, state, and local agencies to support investigative efforts

Minimum Requirements:
- Bachelor's degree and 5+ years of healthcare insurance and investigation experience
- Preferred skills: pharmacy investigation experience and professional certification (CFE, AHFI, CPC, Paralegal, RN, JD)
- Knowledge of plan policies and procedures and negotiation experience
- Intermediate to advanced knowledge of Microsoft Excel

Salary Information:
- Salary range for in-person candidates in California, Colorado, Hawaii, Nevada, New York, Washington State, and Jersey City, NJ: $73,360 to $132,048
- In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution

Company Culture:
- Creating a culture of personal and professional growth
- Values and behaviors drive strategy and success
- Market-competitive total rewards package
- Hybrid workforce strategy with onsite requirements
- Vaccination required for certain patient/member-facing roles
- Equal employment opportunity regardless of protected category
- Accommodation options available for job application process

Join Elevance Health as a Senior Investigator and make a difference in the fight against healthcare fraud. Apply now and become a part of a Fortune 25 company dedicated to improving lives and communities through simpler healthcare solutions.

Not specified.

Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401k contribution.

Not specified.

Investigation, Analysis, Data Mining, Fraud Detection, Information Gathering, Reporting, Communication, Negotiation, Policy Development, Legal Knowledge, Compliance.

BA/BS in related field.

Submit resume to .

Qualification and Experience BA/BS in related field, minimum of 5 years experience in healthcare insurance and healthcare insurance investigation, professional certification preferred.

Legal