Senior Investigator

Min 5 yrs required

Full-time

No

Salary Information:
- The salary for this position ranges from $80,000 to $100,000 per year, depending on experience and qualifications.
- Additional benefits such as medical, dental, vision, and retirement plans are also included.

Job Title:
- Senior Investigator (Investigator Sr)

Experience Information:
- Minimum 5 years of experience in healthcare insurance and healthcare insurance investigation, law enforcement, or a related field required.
- Bachelor's degree in a related field preferred.
- Professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designations are also preferred.

Responsibilities and Duties:
- Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems.
- Independently identify and develop complex cases against perpetrators of healthcare fraud.
- Work with internal senior management and legal departments throughout the investigative process.
- Assist in training internal and external entities on fraud prevention and detection.
- Develop policies and procedures to prevent loss of company assets.
- Represent the company in court proceedings regarding research findings.
- Maintain strong relationships with federal, state, and local law enforcement and regulatory agencies.
- Utilize Microsoft Excel and its functionality for investigations.
- Negotiate with providers on benefit programs management.
- Understand and apply health insurance policies and procedures.
- Work within a hybrid model, with a mix of remote and in-office work.
- Adhere to Elevance Health's values and behaviors to achieve business outcomes and drive success.

H1 and H2 Headings:
H1: Senior Investigator (Investigator Sr) - Elevance Health
H2: Responsibilities and Qualifications

H1: Join the Elevance Health Team as a Senior Investigator
H2: About Elevance Health and the Role

H1: Experience and Qualifications for Senior Investigator
H2: Required and Preferred Skills

H1: Elevance Health's Hybrid Workforce Strategy
H2: Health and Safety at Elevance Health

H1: Elevance Health's Commitment to Diversity and Inclusion
H2: Equal Employment Opportunity at Elevance Health

H1: Salary and Benefits for Senior Investigator Position
H2: Competitive Compensation and Comprehensive Benefits Package

Bullet Points:
- Senior Investigator (Investigator Sr) at Elevance Health
- Full-time position with a hybrid work model (remote and office)
- Ideal candidate lives within 50 miles of Elevance Health PulsePoint locations
- Member of Elevance Health family of companies, Carelon Insights
- Responsible for identifying, investigating, and developing complex cases of healthcare fraud
- Recover corporate and client funds paid on fraudulent claims
- Conduct claim reviews, data mining, and entity reviews
- Work with senior management and legal department throughout investigative process
- Assist in training internal and external entities on fraud prevention
- Develop policies and procedures to prevent loss of company assets
- Represent the company in court proceedings
- Collaborate with federal, state, and local law enforcement and regulatory agencies
- Proficient in Microsoft Excel and its functionality
- Professional certifications preferred
- Knowledge of health insurance policies and procedures
- Hybrid work model with a mix of remote and in-office work
- Elevance Health values and behaviors drive culture and success
- Competitive salary and comprehensive benefits package offered

Bold Headlines:
- Senior Investigator at Elevance Health: Join Our Team
- Hybrid Work Model: Work Remotely and In-Office with Elevance Health
- Elevance Health's Commitment to Diversity and Inclusion
- Competitive Salary and Benefits for Senior Investigator Position

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

Data Mining, Microsoft Excel, Legal Procedures, Healthcare Claims Handling, Provider Network Contracting, Communication, Collaboration, Problem Solving, Time Management

BA/BS in related field

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

Qualification and Experience BA/BS in related field, Professional certification (CFE, AHFI, CPC, Paralegal, RN, JD), Minimum 5 years related experience

Legal