Investigator II

2 weeks ago

Saint Louis MO, United States Elevance Health Full time

Investigator II Responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent Medicaid claims. How You Will Make an Impact: Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state 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 Effectively establish rapport and on-going working relationship with law enforcement 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 Required Qualifications: Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: Candidate Must Reside in Missouri Healthcare experience strongly preferred 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 Health insurance, law enforcement experience preferred Advanced Data analysis experience Strongly preferred Advanced Microsoft Excel experience is a must Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: FRD > Investigation Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

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. 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.

Elevance Health

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