Current jobs related to Senior Fraud Investigation Specialist - Norfolk, Virginia - Elevance Health

  • Investigator I

    2 months ago

    Norfolk, Virginia, United States Elevance Health Full time

    About the Role:We are seeking a skilled Investigator I to join our team at Elevance Health. As a key member of our organization, you will play a critical role in detecting and preventing healthcare fraud, abuse, and wasteful practices.Key Responsibilities:Conduct thorough investigations of assigned cases, analyzing claim data and reviewing professional and...

  • Language Specialist

    4 weeks ago

    Norfolk, Virginia, United States Federal Bureau of Investigation (FBI) Full time

    Job Title: Language SpecialistWe are seeking a highly skilled Language Specialist to join our team at the Federal Bureau of Investigation (FBI). As a Language Specialist, you will play a critical role in supporting the FBI's language-related operations and providing language support to our agents and analysts.Job SummaryThe Language Specialist will be...

  • Language Specialist

    1 month ago

    Norfolk, Virginia, United States Federal Bureau of Investigation (FBI) Full time

    Job Title: Language SpecialistWe are seeking a highly skilled Language Specialist to join our team at the Federal Bureau of Investigation (FBI). As a Language Specialist, you will play a critical role in supporting the FBI's language-related operations and providing language support to our agents and analysts.Job SummaryThe Language Specialist will be...

  • Asset Protection Specialist

    1 week ago

    Norfolk, Virginia, United States Home Depot Full time

    Job Title: Asset Protection SpecialistAt Home Depot, we're committed to providing a safe and secure environment for our customers and employees. As an Asset Protection Specialist, you'll play a critical role in preventing financial loss caused by theft and fraud.Key Responsibilities:Support safety and environmental program compliance in assigned...

  • Nursing Assistant

    1 week ago

    Norfolk, Virginia, United States Senior Lifestyle Full time

    Job SummaryAs a Certified Nursing Assistant at Senior Lifestyle, you will provide high-quality care to our residents. Your responsibilities will include taking and recording vital signs, measuring and recording height and weight, and calculating and recording fluid intake and output. You will also recognize abnormal changes in body functioning and report...

  • Senior Training Specialist

    2 days ago

    Norfolk, Virginia, United States General Dynamics Full time

    Job Title: Training Specialist SeniorJob Summary:We are seeking a highly skilled Training Specialist Senior to join our team at General Dynamics. As a Training Specialist Senior, you will be responsible for developing, organizing, and conducting training and educational programs for customer personnel enrolled in the Undersea Warfare Command Course.Key...

  • Senior Pricing Specialist

    6 days ago

    Norfolk, Virginia, United States Booz Allen Hamilton Full time

    Key Responsibilities:As a Senior Pricing Specialist at Booz Allen Hamilton, you will be responsible for reviewing proposal team inputs to ensure compliance with government regulations, including TINA and certified cost or pricing data. This involves ensuring compliance with internal company policies, the Cost Estimating System Manual (CESM), FAR, CAS, and...

  • Environmental Design Specialist

    2 weeks ago

    Norfolk, Virginia, United States Bristol Industries LLC Full time

    Job Title: Senior Environmental Design SpecialistBristol Infrastructure Design Services, LLC is seeking a highly skilled Senior Environmental Design Specialist to join our team. As a key member of our design team, you will be responsible for supporting facilities and projects for the Department of Navy.Job SummaryThe successful candidate will have experience...

  • Senior ASW Training Specialist

    3 weeks ago

    Norfolk, Virginia, United States General Dynamics Information Technology Full time

    Transform Technology into OpportunityAs a Training Specialist Senior with General Dynamics Information Technology, you will play a critical role in delivering complex technical and tactical training to sailors enrolled in courses taught at Surface Combat Systems Training Command-Hampton Roads (SCSTC-HR) in Norfolk, Virginia.Key Responsibilities:Develop,...

  • Senior ASW Warfare Specialist

    1 week ago

    Norfolk, Virginia, United States General Dynamics Information Technology Full time

    Transform Technology into OpportunityAs a Training Specialist Senior with General Dynamics Information Technology, you will play a critical role in delivering complex technical and tactical training to sailors enrolled in courses taught at Surface Combat Systems Training Command-Hampton Roads (SCSTC-HR) in Norfolk, Virginia.Key Responsibilities:Develop,...

  • Senior Technical Specialist

    7 days ago

    Norfolk, Virginia, United States Naval Systems Full time

    Job Summary:We are seeking a highly skilled Senior Technical Specialist to join our team at Naval Systems. As a Senior Technical Specialist, you will be responsible for providing technical assistance and support to our engineering team.Key Responsibilities:Provide technical assistance and support to the engineering teamAnalyze and troubleshoot technical...

  • Senior ASW Specialist Trainer

    1 month ago

    Norfolk, Virginia, United States General Dynamics Information Technology Full time

    Transform Technology into OpportunityAs a Training Specialist Senior with General Dynamics Information Technology (GDIT), you will play a critical role in enhancing the systems that matter most. Our team is dedicated to delivering complex technical and tactical training to sailors enrolled in courses taught at Surface Combat Systems Training Command-Hampton...

  • Negotiations Specialist Senior

    2 weeks ago

    Norfolk, Virginia, United States Virginia Department of Transportation Full time

    Job Title: Negotiations Specialist SeniorJoin the Virginia Department of Transportation as a Negotiations Specialist Senior and play a critical role in clearing right of way for highway construction projects. As a key member of the Right of Way Division, you will assess situations, apply technical knowledge, and interpret laws and regulations to ensure...

  • Senior Billing Specialist

    2 days ago

    Norfolk, Virginia, United States Booz Allen Hamilton Full time

    Job Summary:We are seeking a highly skilled Senior Billing Specialist to join our team at Booz Allen Hamilton. As a Senior Billing Specialist, you will be responsible for ensuring the accuracy and timeliness of our client invoices.Key Responsibilities:Prepare and process client invoices in a timely and accurate manner.Reconcile unbilled balances and monitor...

  • Senior IT Specialist

    1 week ago

    Norfolk, Virginia, United States Metronome LLC Full time

    Job SummaryWe are seeking a highly skilled Senior IT Specialist to join our team at Metronome LLC. The ideal candidate will have a strong background in IT and a proven track record of success in leading complex projects.Key Responsibilities:Provide consultation on complex projects and lead the work of others.Organize and direct the configuration and...

  • Senior Billing Specialist

    2 days ago

    Norfolk, Virginia, United States Booz Allen Hamilton Full time

    Job Summary:We are seeking a highly skilled Senior Billing Specialist to join our team at Booz Allen Hamilton. As a Senior Billing Specialist, you will be responsible for ensuring the effective and efficient processing of invoices, reconciliations, and collections. You will work closely with internal and external stakeholders to understand their needs and...

  • Senior Grants and Contracts Specialist

    1 week ago

    Norfolk, Virginia, United States Virginia Department of Human Resource Management Full time

    Job Summary: We are seeking a highly skilled Senior Grants and Contracts Specialist to join our team at the Virginia Department of Human Resource Management. The successful candidate will be responsible for providing high-level administrative support by conducting research, reviewing and editing technical reports, and handling information requests. The ideal...

  • Senior Clinical Data Quality Specialist

    4 weeks ago

    Norfolk, Virginia, United States Shaker for ChristianaCare Direct Full time

    Job Title: Senior Clinical Data Quality SpecialistShaker for ChristianaCare Direct is seeking a highly skilled Senior Clinical Data Quality Specialist to join our team. As a key member of our quality team, you will play a critical role in ensuring the accuracy and integrity of clinical data for our Thoracic Surgery service line.Key Responsibilities:Lead and...

  • Senior IT Operations Specialist

    7 days ago

    Norfolk, Virginia, United States Metronome LLC Full time

    Job SummaryWe are seeking a highly skilled Senior IT Operations Specialist to join our team at Metronome LLC. The ideal candidate will have extensive experience in planning and accomplishing goals, with a strong background in system administration and management.Key Responsibilities:Plan and execute system operations and maintenance tasksLead and direct the...

  • Senior Learning and Development Specialist

    4 weeks ago

    Norfolk, Virginia, United States Titan America Full time

    Job Title: Senior Learning and Development SpecialistTitan America LLC is seeking a highly skilled Senior Learning and Development Specialist to join our team. As a key member of our Learning and Development department, you will play a vital role in designing, developing, and delivering high-quality learning experiences to enhance the knowledge and skills of...

Senior Fraud Investigation Specialist

2 months ago

Norfolk, Virginia, United States Elevance Health Full time

Company Overview:

Elevance Health is a leading organization dedicated to enhancing healthcare outcomes. We are committed to integrity and excellence in all our operations.

Position Overview:

The Senior Fraud Investigation Specialist plays a pivotal role in safeguarding our resources by identifying and investigating complex cases of healthcare fraud. This position operates on a hybrid model, allowing for both remote and in-office work.

Key Responsibilities:

  • Conduct thorough claim reviews to ensure accurate coding and compliance.
  • Utilize advanced data analysis techniques for entity assessments and law enforcement referrals.
  • Lead enterprise-wide investigations that may affect multiple health plans and jurisdictions.
  • Collaborate with senior management and legal teams throughout the investigative process.
  • Facilitate training sessions for both internal staff and external partners.
  • Contribute to the development of policies aimed at minimizing financial losses.
  • Represent the organization in legal proceedings, presenting findings from investigations.
  • Establish and maintain strong relationships with federal, state, and local law enforcement agencies to enhance investigative efforts.

Qualifications:

A bachelor’s degree is required, along with a minimum of five years of relevant experience in healthcare insurance investigations or law enforcement. Candidates should possess a solid understanding of health insurance policies and claims processing.

Preferred Skills:

  • Professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or similar are highly regarded.
  • In-depth knowledge of benefit program management and negotiation practices is advantageous.
  • Bilingual proficiency in Spanish is preferred.

Compensation:

The salary range for this position is competitive and based on various legitimate factors set by the company.

Benefits:

Elevance Health offers a comprehensive benefits package, including incentive programs, equity stock purchase options, and 401k contributions, all subject to eligibility requirements.