Job Details

Investigator I Ii Or Senior

Company name

Anthem, Inc.

Organization Type

In-House

Job Type

Legal Staff

Date Last Verified

May 21,2019

Valid Through

Sep 03,2019

Posted on

Apr 17,2019

Location

Des Moines, IA, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Health Care >> Health Care
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Investigator I, II or Senior
The candidate will claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and/or state. May interface internally with Senior level management and legal department throughout investigative process. May assist in training of internal and external entities. Assists in the development of policy and/or procedures to prevent loss of company assets. May be called upon to represent the Company in court proceedings regarding research findings. Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting. Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts.

Qualification and Experience

The candidate must have the following qualifications:
Investigator I: Requires BA/BS, 2+ years related experience preferably in healthcare insurance, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Investigator II: Requires BA/BS degree, 3+ years related experience; or any combination of education and experience, which would provide an equivalent background. Fraud certification from CFE, AHFI, AAPC or coding certificates preferred. Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

Investigator Senior: Requires BA/BS degree 5+ years related experience in healthcare insurance and healthcare insurance investigation, law enforcement or any combination of education and experience which would provide an equivalent background.

Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred. Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

Preferred experience (beyond requirements for each level): Medicaid/Medicare experience and Behavioral Health Investigations experience.

Additional info

Ref: PS17158

Company info

Hiring Coordinator
Anthem, Inc.
120 Monument Circle
Indianapolis, IN 46204

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