Senior Investigator Research Grant
4 weeks ago
Job Summary:
The Senior Investigator is responsible for the independent identification, investigation, and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims.
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional, and pharmacy claims.
May interface internally with Senior level management and legal department throughout investigative process.
May assist in training of internal and external entities.
Assists in the development of policy and/or procedures to prevent loss of company assets.
Health insurance experience required with understanding of health insurance policies, health insurance claims handling, and provider network contracting.
Develops and maintains a high degree of rapport and cooperation with the Federal, State, and local law enforcement and regulatory agencies which can assist in investigative efforts.
Proficient in the utilization of Microsoft Excel and its functionality strongly preferred.
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler.
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.
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
They are how we achieve our strategy, power our business outcomes, and drive our shared success – for our consumers, our associates, our communities, and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.
Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. Elevance Health will also follow all relevant federal, state, and local laws.
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.
Applicants who require accommodation to participate in the job application process may contact for assistance.
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