Investigator Senior

4 days ago

Walnut Creek, California, United States Elevance Health Full time
Job Title: Investigator Senior

We are seeking a highly skilled Investigator Senior to join our team at Elevance Health. As a key member of our Payment Integrity line of business, you will play a critical role in identifying, investigating, and developing complex cases against perpetrators of healthcare fraud.

Key Responsibilities:
  • Conduct in-depth claim reviews to identify potential healthcare fraud
  • Develop and implement investigative strategies to recover corporate and client funds
  • Collaborate with internal stakeholders, including senior management and the legal department, to ensure effective case management
  • Interface with external agencies, such as law enforcement and regulatory bodies, to gather information and support investigative efforts
  • Develop and maintain a high degree of rapport and cooperation with external agencies
Requirements:
  • Bachelor's degree in a related field, such as healthcare administration or business
  • Minimum 5 years of experience in healthcare insurance and investigation, law enforcement, or a related field
  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
  • Ability to work independently and as part of a team
Preferred Qualifications:
  • Professional certification, such as CFE or AHFI
  • Knowledge of healthcare policies and procedures
  • Bilingual candidate who can speak Spanish
What We Offer:

Elevance Health offers a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) + match and stock purchase plan. We also offer incentive and recognition programs, equity stock purchase, and a range of other benefits.

As a member of our team, you will have the opportunity to work in a dynamic and supportive environment, with a focus on making a positive impact on our members and the communities we serve.

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