Investigator II
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Nashville, TN, USA, Miami, FL, USA, Atlanta, GA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
Requirements
- Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Responsibilities
- 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.
- 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.
- Effectively establish rapport and on-going working relationship with law enforcement.
- 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.
Preferred Qualifications
- 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.
- Investigation experience strongly preferred.
- Experience with Medicare fraud, waste, and abuse preferred.