Elevance Health Inc
Overview
Senior Investigator – Payment Integrity (Hybrid)
About the Role
Supports the Payment Integrity line of business. Hybrid 1 — 1-2 days per week in office.
Responsibilities
Independent identification, investigation and development of complex cases against perpetrators of healthcare fraud to recover corporate and client funds.
Claim reviews, data mining, entity review, law enforcement referral, using proprietary data and claim systems for facility, professional and pharmacy claims.
Develop enterprise-wide specific healthcare investigations and initiatives that may impact multiple health plans and lines of business.
Interface with senior management and legal department throughout investigative process.
Assist in training internal and external entities.
Represent the Company in court proceedings regarding findings.
Develop and maintain relationship with federal, state and local law enforcement and regulatory agencies to assist investigations.
Requirements
BA / BS and minimum of 5 years experience in healthcare insurance, healthcare insurance investigation or law enforcement, or equivalent combination.
Preferred Qualifications
Professional certification such as CFE, AHFI, CPC, Paralegal, RN, JD or other relevant designation.
Knowledge of plan policies and procedures in all facets of benefit programs management with emphasis on negotiation.
Location & Compensation Open in California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, New York, Washington State. Salary range $78,400 to $141,120.
Benefits
Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution.
Additional benefits subject to eligibility.
EEO Statement 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, 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@e relevancehealth.com for assistance.
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About the Role
Supports the Payment Integrity line of business. Hybrid 1 — 1-2 days per week in office.
Responsibilities
Independent identification, investigation and development of complex cases against perpetrators of healthcare fraud to recover corporate and client funds.
Claim reviews, data mining, entity review, law enforcement referral, using proprietary data and claim systems for facility, professional and pharmacy claims.
Develop enterprise-wide specific healthcare investigations and initiatives that may impact multiple health plans and lines of business.
Interface with senior management and legal department throughout investigative process.
Assist in training internal and external entities.
Represent the Company in court proceedings regarding findings.
Develop and maintain relationship with federal, state and local law enforcement and regulatory agencies to assist investigations.
Requirements
BA / BS and minimum of 5 years experience in healthcare insurance, healthcare insurance investigation or law enforcement, or equivalent combination.
Preferred Qualifications
Professional certification such as CFE, AHFI, CPC, Paralegal, RN, JD or other relevant designation.
Knowledge of plan policies and procedures in all facets of benefit programs management with emphasis on negotiation.
Location & Compensation Open in California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, New York, Washington State. Salary range $78,400 to $141,120.
Benefits
Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution.
Additional benefits subject to eligibility.
EEO Statement 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, 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@e relevancehealth.com for assistance.
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