Investigator Senior

Min 5 yrs required

Full-time

No

Summary:

- Job Title: Investigator Senior
- Job Family: FRD > Investigation
- Type: Full time
- Date Posted: Apr 23, 2024
- Anticipated End Date: May 27, 2024
- Reference: JR111706
- Location: Hybrid model (remote and office)
- Company: Elevance Health
- Department: Carelon Payment Integrity
- Experience: Minimum of 5 years in healthcare insurance and investigation
- Salary: $73,360 to $132,048 (based on location and experience)
- Benefits: Comprehensive package, incentive and recognition programs, equity stock purchase, 401k contribution, and more
- Vaccination Requirement: All new candidates in certain patient/member-facing roles must be vaccinated against COVID-19

Responsibilities:

- Independently identify and develop complex cases against perpetrators of healthcare fraud
- Conduct claim reviews and investigations using proprietary data and claim systems
- Interface with senior level management and legal department
- Assist in training internal and external entities
- Develop policies and procedures to prevent loss of company assets
- Represent the company in court proceedings
- Maintain rapport and cooperation with law enforcement and regulatory agencies

Minimum Requirements:

- BA/BS degree
- Minimum of 5 years related experience in healthcare insurance and investigation or equivalent combination of education and experience
- Understanding of health insurance policies, claims handling, and provider network contracting

Preferred Qualifications:

- Professional certification (CFE, AHFI, CPC, Paralegal, RN, JD)
- Knowledge of Plan policies and procedures and negotiation skills
- Bilingual (Spanish) preferred

Who We Are:

- Elevance Health
- Fortune 25 company in the healthcare industry
- Dedicated to improving lives and communities
- Creating a culture for personal and professional growth

How We Work:

- Values and behaviors drive our culture and success
- Market-competitive total rewards package
- Hybrid Workforce Strategy with some in-person work required
- Top priority on the health of associates and communities

EEO Statement:

- Equal Employment Opportunity employer
- 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 laws.

Not specified

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

Not specified

Data mining, entity review, claim review, policy development, training, court proceedings, rapport building, healthcare policies and procedures, bilingual (Spanish)

BA/BS

Submit resume to

Qualification and Experience BA/BS, professional certification (CFE, AHFI, CPC, Paralegal, RN, JD), health insurance experience

Legal