Elevance Health
Title:
Investigator II
Locations:
Indianapolis, IN; Columbus, OH; Nashville, TN
Hybrid:
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility. Alternate locations may be considered if within commuting distance.
Primary Duties:
Claim reviews for coding, data mining, entity review, law enforcement referral, and use of proprietary claim systems for facility, professional, and pharmacy claims.
Identify and develop enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business, and/or state.
Establish rapport and ongoing working relationship with law enforcement.
Interface internally with senior level management and legal department throughout investigative process.
Assist in training of internal and external entities.
Assist in development of policy and procedures to prevent loss of company assets.
Minimum Requirements:
BA/BS and minimum of 3 years related experience; or equivalent combination.
Preferred Skills:
Fraud certification from CFE, AHFI, AAPC or coding certificates.
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis on negotiation.
Health insurance, law enforcement experience.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
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Investigator II
Locations:
Indianapolis, IN; Columbus, OH; Nashville, TN
Hybrid:
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility. Alternate locations may be considered if within commuting distance.
Primary Duties:
Claim reviews for coding, data mining, entity review, law enforcement referral, and use of proprietary claim systems for facility, professional, and pharmacy claims.
Identify and develop enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business, and/or state.
Establish rapport and ongoing working relationship with law enforcement.
Interface internally with senior level management and legal department throughout investigative process.
Assist in training of internal and external entities.
Assist in development of policy and procedures to prevent loss of company assets.
Minimum Requirements:
BA/BS and minimum of 3 years related experience; or equivalent combination.
Preferred Skills:
Fraud certification from CFE, AHFI, AAPC or coding certificates.
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis on negotiation.
Health insurance, law enforcement experience.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
#J-18808-Ljbffr