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Healthcare Fraud Investigator

1 month ago


Columbus, Ohio, United States Elevance Health Full time

Job Summary:

We are seeking a skilled Investigative Analyst II to join our team at Elevance Health. As a key member of our Payment Integrity department, you will play a critical role in identifying, investigating, and developing cases against perpetrators of healthcare fraud.

Key Responsibilities:

  • Conduct in-depth claim reviews to identify potential fraud and abuse
  • Develop and implement investigative strategies to recover corporate and client funds
  • Collaborate with law enforcement agencies to effectively establish rapport and working relationships
  • Interface with senior-level management and legal departments throughout the investigative process
  • Assist in training internal and external entities on investigative procedures and policies

Requirements:

  • Bachelor's degree in a related field (e.g., healthcare administration, business, or a related field)
  • Minimum 3 years of experience in a related field, with a focus on healthcare fraud investigation or a related field
  • Fraud certification from CFE, AHFI, AAPC, or coding certificates preferred
  • Knowledge of plan policies and procedures in all facets of benefit programs management, with a heavy emphasis on negotiation
  • Health insurance and law enforcement experience preferred

What We Offer:

  • A competitive salary and benefits package
  • Opportunities for professional growth and development
  • A dynamic and supportive work environment
  • The chance to make a meaningful impact in the healthcare industry

How to Apply:

Please submit your resume and cover letter to [insert contact information]. We look forward to hearing from you