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SIU Investigator
| Company | Centene |
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| Location | California, USA |
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| Salary | $26.5 – $47.59 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Junior |
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Requirements
- Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience
- 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience
- Knowledge of Microsoft Applications
- Knowledge of medical coding and terminology preferred
Responsibilities
- Conduct investigations of potential waste, abuse, and fraud
- Document activity on each case and refer issues to the appropriate party
- Perform data mining and analysis to detect aberrancies and outliers in claims
- Develop new queries and reports to detect potential waste, abuse, and fraud
- Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
- Assist with complex allegations of healthcare fraud
- Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
- Complete various special projects and audits
Preferred Qualifications
- Knowledge of medical coding and terminology preferred
