Senior Investigator

Min 5 yrs required

Full-time

No

H1: Senior Investigator Opportunity at Elevance Health: $73,360 to $132,048 Salary Range
H2: Join Our Team and Make an Impact in Healthcare Fraud Investigation

- Role: Senior Investigator
- Job Family: FRD > Investigation
- Type: Full time
- Date Posted: Apr 17, 2024
- Anticipated End Date: May 06, 2024
- Reference: JR112660
- Location: Hybrid model (remote and office)
- Schedule: 1-2 days per week in the office
- Ideal candidate must live within 50 miles of Elevance Health PulsePoint locations
- Responsible for independent identification, investigation, and development of healthcare fraud cases
- Recover corporate and client funds paid on fraudulent claims
- Must have a strong pharmacy investigation background
- Claim reviews for appropriate coding, data mining, and entity review
- Law enforcement referral and use of proprietary data and claim systems
- Responsible for identifying and developing enterprise-wide investigations and initiatives
- May interface with senior level management and legal department
- May assist in training of internal and external entities
- Develops policy and procedures to prevent loss of company assets
- Represents the company in court proceedings
- Health insurance experience required
- Understanding of health insurance policies, claims handling, and provider network contracting
- Develops and maintains rapport with law enforcement and regulatory agencies
- Requires BA/BS and minimum of 5 years related experience in healthcare insurance and investigation
- Preferred skills: pharmacy investigation experience, professional certification, knowledge of plan policies and procedures, negotiation skills, intermediate to advanced knowledge of Microsoft Excel
- Salary range for in-person positions: $73,360 to $132,048
- Locations: California, Colorado, Hawaii, Nevada, New York, Washington State, Jersey City, NJ
- Comprehensive benefits package, equity stock purchase, and 401k contribution offered
- Equal pay opportunities for equal work regardless of gender, race, or any other category protected by pay equity laws
- Hybrid workforce strategy in place
- Vaccination against COVID-19 required for certain patient/member-facing roles
- Elevance Health is an Equal Employment Opportunity employer
- Contact for accommodations during the application process

Not specified.

Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401k contribution, health insurance, paid time off, bonuses, wellness programs, financial education resources.

Not specified.

Investigation, data mining, entity review, claim review, coding, proprietary data systems, healthcare policies and procedures, Microsoft Excel, communication, negotiation, legal knowledge, regulatory knowledge, attention to detail, critical thinking, problem-solving.

Bachelor's degree in a related field (e.g. healthcare, law enforcement, business).

Interested candidates can apply through the Elevance Health website or by emailing their resume to .

Qualification and Experience Bachelor's degree in a related field (e.g. healthcare, law enforcement, business), minimum of 5 years experience in healthcare insurance and investigation, professional certification (e.g. CFE, AHFI, CPC, Paralegal, RN, JD) preferred.

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