Investigator II
1 week ago
Join Elevance Health as an Investigator II and play a critical role in identifying, investigating, and developing cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims.
About the Role:We are seeking a highly skilled and experienced Investigator II to join our team. As an Investigator II, you will be responsible for:
- Conducting 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.
- Identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business, and/or state.
- Establishing rapport and on-going working relationships with law enforcement.
- Interfacing internally with Senior level management and legal department throughout the investigative process.
- Assisting in training of internal and external entities.
- Assisting in the development of policy and/or procedures to prevent loss of company assets.
To be successful in this role, you will need:
- A BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
- Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
- Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
- Health insurance, law enforcement experience 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.
What We Offer: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.
We operate in a Hybrid Workforce Strategy. 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. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. 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 HR@ElevanceHealth.com for assistance.
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