Title: Pharmacy Investigator Senior Job Responsibilities: - Independently identify, investigate, and develop complex cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. - Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral,...
Title: Vice President & Associate General Counsel, Clinical Operations Job Responsibilities: The Vice President & Associate General Counsel for Clinical Operations is a pivotal role within the company's Law Department, primarily tasked with advising the company's care delivery lines, specifically...
Title: Legal Counsel, Carelon Contracting Job Responsibilities: - Negotiate and manage client contracts with entities such as health plan clients, state agencies, employer groups, and other clients associated with the Carelon Services businesses. This includes areas like behavioral health, medical benefits utilization...
Title: Senior Fraud and Waste Professional Job Responsibilities: The Senior Fraud and Waste Professional is responsible for conducting investigations into allegations of fraudulent and abusive practices within the healthcare industry. This role involves dealing with moderately complex to complex issues that require...
Title: Fraud and Waste Investigator Job Responsibilities: The Fraud and Waste Investigator is a pivotal role within the company's Special Investigations Unit, focusing on combating fraud, waste, and abuse in the healthcare industry. The primary responsibilities include conducting thorough investigations into allegations...
Title: Compliance Analyst - ICHRA Job Responsibilities: - Assist the Director of E&C (ICHRA) in building and implementing the Individual Coverage Health Reimbursement Arrangement (ICHRA) compliance program. - Serve as an enterprise-wide resource and liaison for ICHRA, providing subject matter expertise and compliance...