Senior Investigator

Min 5 yrs required

Full-time

No

Senior Investigator - Full Time Position at Elevance Health

Salary Information:

$85,000 - $110,000 per year

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

H1 and H2 Friendly Headings:

H1: Senior Investigator - Join the Elevance Health Team and Make an Impact in Healthcare

H2: Location and Job Description

H2: Responsibilities and Requirements

H2: Who We Are and How We Work

H2: Salary Information and Employment Details

Description:

Elevance Health is seeking a Senior Investigator to join their team and make a difference in the healthcare industry. This full-time position will work a hybrid model, with both remote and office work, and the ideal candidate will live within 50 miles of one of Elevance Health's PulsePoint locations. As a proud member of the Elevance Health family of companies, Carelon Insights is dedicated to recovering, eliminating, and preventing unnecessary medical-expense spending.

Responsibilities:

As a Senior Investigator, you will be responsible for independently identifying, investigating, and developing complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. Your role will involve claim reviews, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems. You will also be responsible for developing and maintaining a high degree of rapport and cooperation with federal, state, and local law enforcement and regulatory agencies.

Requirements:

To be considered for this position, you must have a BA/BS and a minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement, or any combination of education and experience that would provide an equivalent background. Proficiency in Microsoft Excel and professional certification in CFE, AHFI, CPC, Paralegal, RN, JD, or another job-related designation are preferred. Knowledge of plan policies and procedures in all facets of benefit programs management is also desired.

Who We Are:

Elevance Health is a Fortune 25 company with a longstanding history in the healthcare industry. We are dedicated to improving lives and communities and making healthcare simpler. Our culture is rooted in our values and behaviors, which drive our strategy and lead to personal and professional growth for our associates. We offer a range of market-competitive total rewards, including merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Employment Details:

Elevance Health operates on a hybrid workforce strategy, meaning associates are required to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or a 1-hour commute each way of a relevant Elevance Health location. We also require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19. Elevance Health is an equal employment opportunity employer and offers accommodations for applicants who require assistance with the job application process.

Not specified

Merit increases, Paid holidays, Paid Time Off, Incentive bonus programs, Medical, Dental, Vision, Short and long term disability benefits, 401(k) +match, Stock purchase plan, Life insurance, Wellness programs, Financial education resources

Not specified

Investigative skills, Data analysis, Microsoft Excel proficiency, Legal knowledge, Communication, Collaboration, Problem-solving, Policy development, Training, Report writing, Strategic thinking

Bachelor's degree (BA/BS)

Interested candidates can apply through the Elevance Health website or through a signed agreement with Elevance Health for agency representation.

Qualification and Experience Bachelor's degree in a related field (BA/BS), 5+ years of experience in healthcare insurance or investigation, Professional certifications (CFE, AHFI, CPC, Paralegal, RN, JD), Knowledge of health insurance policies and procedures, Understanding of legal proceedings and regulations, Experience in plan management and negotiation

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