Healthcare Investigator

3 weeks ago


Louisville, Kentucky, United States Elevance Health Full time

Job Summary:

Carelon Payment Integrity, a proud member of the Elevance Health family of companies, is seeking a skilled Healthcare Investigator to join our team. As a Healthcare Investigator, you will play a critical role in detecting and preventing fraudulent, abusive, or wasteful activities in our healthcare insurance payments.

Key Responsibilities:

  • Investigate assigned cases to detect and prevent fraudulent, abusive, or wasteful activities in healthcare insurance payments.
  • Collect, research, and analyze claim data to identify potential issues.
  • Prepare statistical and financial analyses to document findings and maintain up-to-date electronic case files.
  • Collaborate with cross-functional teams to develop and implement strategies to prevent and detect fraudulent activities.

Requirements:

  • Bachelor's degree in a related field, such as healthcare administration, business, or a related field.
  • Minimum of 2 years of experience in healthcare insurance, law enforcement, or a related field.
  • Proficient in Microsoft Excel and other analytical tools.

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.

What We Offer:

  • Market-competitive total rewards, including merit increases, paid holidays, and incentive bonus programs.
  • Medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

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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