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Investigator

4 weeks ago


Grand Prairie, Texas, United States Elevance Health Full time
Job Title: Investigator I

Elevance Health is seeking a skilled Investigator I to join our team. As an Investigator I, you will play a critical role in detecting and preventing fraudulent activities in our healthcare insurance programs.

Key Responsibilities:
  • Conduct thorough investigations of assigned cases to identify and prevent fraudulent, abusive, or wasteful activities.
  • Analyze claim data and review professional and facility claims to detect potential issues.
  • Prepare statistical and financial analyses and reports to document findings and maintain up-to-date electronic case files.
  • Communicate findings to management and stakeholders, including providers and subscribers.
  • Collaborate with internal teams to develop and implement strategies to prevent and detect fraud.
Requirements:
  • Bachelor's degree in a related field, such as healthcare administration or business.
  • Minimum of 2 years of experience in a related field, such as healthcare insurance, law enforcement, or compliance.
  • Fraud certification from a recognized organization, such as CFE or AHFI, is preferred.
What We Offer:
  • A competitive salary and benefits package.
  • Opportunities for professional growth and development.
  • A dynamic and supportive work environment.

Elevance Health is an Equal Employment Opportunity employer and welcomes applications from diverse candidates. If you are passionate about making a difference in the healthcare industry and have the skills and experience to succeed in this role, we encourage you to apply.