Elevance Health
Investigator II – Elevance Health
The Investigator II role at Elevance Health focuses on identifying, investigating, and developing cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims.
Base Pay Range $69,440.00/yr - $104,160.00/yr
Locations Indianapolis, IN; Nashville, TN; Columbus, OH
Hybrid Work Setup Associates are required to be in-office 1-2 days per week while providing flexibility for virtual work. Candidates must be within a reasonable commuting distance from the posting location(s). Alternate locations may be considered if residing within commuting distance.
Responsibilities
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.
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/or procedures to prevent loss of company assets.
Minimum Requirements
BA/BS and minimum of 3 years related experience; or equivalent combination of education and experience.
Preferred Skills, Capabilities And Experiences
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 in negotiation.
Health insurance, law enforcement experience.
Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution. Benefits are subject to eligibility requirements.
Equal Employment Opportunity 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 (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.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Other
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Base Pay Range $69,440.00/yr - $104,160.00/yr
Locations Indianapolis, IN; Nashville, TN; Columbus, OH
Hybrid Work Setup Associates are required to be in-office 1-2 days per week while providing flexibility for virtual work. Candidates must be within a reasonable commuting distance from the posting location(s). Alternate locations may be considered if residing within commuting distance.
Responsibilities
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.
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/or procedures to prevent loss of company assets.
Minimum Requirements
BA/BS and minimum of 3 years related experience; or equivalent combination of education and experience.
Preferred Skills, Capabilities And Experiences
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 in negotiation.
Health insurance, law enforcement experience.
Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution. Benefits are subject to eligibility requirements.
Equal Employment Opportunity 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 (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.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Other
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