Investigator I

2 weeks ago


Norfolk, United States Elevance Health Full time

Job Description

:

Investigator I

This position will work a hybrid model (remote and office), 1-2 times per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

The Investigator I is responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices.

How you will make an impact:

Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers. 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.  Effectively establish rapport and on-going working relationship with law enforcement. Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state. Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review. Preparation of final case reports and notification of findings letters to providers. Receive offers of settlement for review and discussion with management. Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings. 

Minimum Requirements:

Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred.  Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred. Excel knowledge a plus. Experience within Managed Care Organization a plus.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

FRD > Investigation

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

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.

How We Work

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. Our values and behaviors are the root of our culture. 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.

Elevance Health operates 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 for assistance.


  • Investigator I

    7 days ago


    Norfolk, Virginia, United States Elevance Health Full time

    About the Role:The Investigator I is a key member of our team at Elevance Health, responsible for investigating assigned cases to detect fraudulent, abusive, or wasteful activities in the healthcare insurance industry.Key Responsibilities:Conduct thorough investigations of claim data to identify potential fraud, abuse, or waste.Analyze data and review...

  • Investigator I

    3 hours 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...


  • Norfolk, United States Cadmus Group Full time

    Experienced or Credentialed Background Investigator- NationwideJob Category: Service Contract ActTime Type: Full timeMinimum Clearance Required to Start: Top SecretEmployee Type: RegularPercentage of Travel Required: Up to 25%Type of Travel: Local* * *At CACI, background investigation is more than research and reports; it's your chance to contribute to the...


  • Norfolk, United States Mirion Full time

    Description * Inspect and test supplier supplied materials, assess and verify conformance to specifications and assess and verify vendor capability Must be a self-starter with the ability to complete assignments on time. * Inspect and test customer returns; coordinate repair and calibration activities of customer owned product; facilitate activities...

  • Store Worker I

    2 months ago


    Norfolk, United States PRIDE Industries Full time

    Pay Rate: $18.36 per hour Telecommute Status: Onsite Announcement: PRIDE Industries is a fast-paced company with a mission: To Create Jobs for People with Disabilities while providing high quality, value-added solutions to our nationwide customers. We are currently recruiting to fill the following position: AbilityOne: This position is on a federal...

  • Research Technician I

    1 month ago


    Norfolk, United States SoBran, Inc. Full time

    Job DescriptionJob DescriptionDESCRIPTION OF DUTIES:Primary duties may include the following:*All employees are expected to perform their duties as assigned, arrive to work at 7:30am and depart at 4:00pm M-F. You will be required to work on the weekends as scheduled. The weekend hours are from 7:30am-12:30am.This person is expected to be familiar with the...

  • Practice Manager I

    5 days ago


    Norfolk, Virginia, United States Eastern Virginia Medical School Full time

    Job SummaryWe are seeking a highly skilled and experienced Practice Manager I to join our team at Eastern Virginia Medical School. The successful candidate will be responsible for overseeing the day-to-day operations of our clinical practice, ensuring the delivery of high-quality patient care and maintaining the highest standards of clinical excellence.Key...


  • Norfolk, Virginia, United States City of Norfolk, VA Full time

    Position OverviewThe City of Norfolk, Virginia is seeking a dedicated individual for the role of Mechanical Compliance Inspector I. This position plays a crucial role in ensuring that all mechanical systems and installations adhere to established codes and standards.Key Responsibilities- Conduct thorough reviews and inspections of building plans for new...


  • Norfolk, Virginia, United States Xylem I LLC Full time

    Job OverviewKey Responsibilities:Deliver risk advisory services across various operational sectors and facilitate the execution of effective solutions.Examine data sets, recognize potential risks and patterns, and offer oversight and direction during risk evaluations, incidents, and compliance audits.Work collaboratively with fellow risk management...


  • Norfolk, Virginia, United States Xylem I LLC Full time

    Job OverviewSummaryThe Employee Relations Specialist is responsible for assisting in the collection, management, and organization of various documents and records related to employee relations.Key ResponsibilitiesTo accommodate individuals with disabilities, reasonable adjustments may be implemented to facilitate the performance of essential duties.Act as...


  • Norfolk, Virginia, United States Xylem I LLC Full time

    Job OverviewSummaryThe Employee Relations Specialist is responsible for supporting the collection, organization, and management of employee-related documentation and records.Key ResponsibilitiesAccommodations may be provided to assist individuals with disabilities in fulfilling essential job functions.Act as the primary point of contact for the intake and...


  • Norfolk, United States Xylem I LLC Full time

    Job DescriptionJob DescriptionSummary/ObjectiveThe Employee Relations Specialist will assist with gathering, collecting, processing, and maintaining documents and records.Essential FunctionReasonable accommodation may be made to enable individuals with disabilities to perform essential functions.Serve as initial contact and liaison for intake and assessment...

  • Crew Leader I

    4 days ago


    Norfolk, Virginia, United States City of Norfolk, VA Full time

    Job SummaryWe are seeking a highly skilled and experienced Crew Leader I to join our team at the City of Norfolk, VA. As a key member of our Infrastructure Maintenance team, you will be responsible for leading a crew of maintenance personnel in the performance of various tasks related to storm water management.Key ResponsibilitiesLead a crew of maintenance...

  • Quality Inspector I-II

    2 months ago


    Norfolk, United States Mirion Full time

    • Inspect and test supplier supplied materials, assess and verify conformance to specifications and assess and verify vendor capability Must be a self-starter with the ability to complete assignments on time. • Inspect and test customer returns; coordinate repair and calibration activities of customer owned product; facilitate activities associated with...

  • Craft Supervisor I

    1 month ago


    Norfolk, Virginia, United States BAE Systems Full time

    Job Description BAE Systems Norfolk Ship Repair is hiring a Craft Supervisor in the Electrical Shop. The applicant will be responsible for overseeing Electrical Shop (regular and temporary employees), assigning work on multiple assignments during a workday and monitoring progress onboard vessels. The selected candidate will be providing technical assistance...

  • Safety Supervisor I

    1 month ago


    Norfolk, Virginia, United States BAE Systems Full time

    Job Description How does it feel to work on a team driven to make a big impact? Empowering.We are seeking a dedicated and proactive Safety Supervisor I to join our team. This role is pivotal in ensuring a safe working environment while driving continuous process improvement and fostering strong leadership and team-building values. The ideal candidate will...


  • Norfolk, United States Pavion Corp Full time

    Description Pavion and our family of companies are seeking a talented and motivated Customer Support Coordinator to join our security business unit. Primary Responsibilities: Serve as a liaison between customers and Security Source Collaborate with customers to ensure timely fulfillment of all corporate requests Provide daily reporting on all corporate...


  • Norfolk, United States Pavion Corp Full time

    Description Pavion and our family of companies are seeking a talented and motivated Customer Support Coordinator to join our security business unit. Primary Responsibilities: Serve as a liaison between customers and Security Source Collaborate with customers to ensure timely fulfillment of all corporate requests Provide daily reporting on all corporate...

  • Craft Supervisor I

    1 month ago


    Norfolk, Virginia, United States BAE Systems Full time

    Job Description What's it like working for an innovative company that takes on some of the world's most important challenges? Rewarding. As part of our ship repair division you can help us ensure the integrity and reliability of some of our most important products. Right now we are looking for Supervisors in our Electric Shop to join our teams working aboard...

  • Operations Analyst I

    3 months ago


    Norfolk, United States Synectic Solutions Inc Full time

    Job DescriptionJob DescriptionPrimary Functions: Apply analytical methods from mathematics, science, and engineering.Perform operations research analysts may be concerned with diverse issues such as top-level strategy, planning and forecasting.Review resource allocation, performance measurements, scheduling, and the design of production facilities.Utilize...