Healthcare Investigator

4 weeks ago

Durham, North Carolina, United States Elevance Health Full time

Job Summary:

The Healthcare Investigator I role at Elevance Health involves investigating assigned cases to detect fraudulent, abusive, or wasteful activities/practices in healthcare insurance payments to providers and subscribers.

Key Responsibilities:

  • Utilize system tools and databases to analyze data and review professional and facility claims.
  • Prepare statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files.
  • Prepare final case reports and notification of findings letters to providers.
  • Communicate with customers, internal and external, regarding findings.

Requirements:

  • Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments or law enforcement.

Preferred Skills:

  • Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
  • Knowledge of Plan policies and procedures in all facets of benefit programs management.

About Elevance Health:

Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Our Culture:

We are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture, driving our shared success for our consumers, associates, communities, and business.

Benefits:

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also provide medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Hybrid Workforce Strategy:

Elevance Health operates in a Hybrid Workforce Strategy, requiring associates 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.

Equal Employment Opportunity:

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.

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