Investigator I - Carelon Payment Integrity

Elevance Health • Richmond, VA

403d

About The Position

The Investigator I position at Carelon Payment Integrity involves investigating cases related to healthcare insurance claims to identify fraudulent, abusive, or wasteful practices. This role requires the use of analytical tools and databases to assess claims, prepare reports, and communicate findings effectively with stakeholders.

Requirements

• Bachelor's degree (BA/BS) required.
• Minimum of 2 years related experience in healthcare insurance, law enforcement, or similar fields.
• Experience in Grievance and Appeals, Contracting, or Claim Operations is preferred.

Responsibilities

• Investigate assigned cases related to healthcare insurance claims.
• Collect, research, and analyze claim data to detect fraudulent or wasteful activities.
• Utilize system tools and databases for data analysis and review of claims.
• Prepare statistical and financial analyses to document findings.
• Maintain up-to-date electronic case files for management review.
• Prepare final case reports and notification letters to providers regarding findings.
• Communicate findings to internal and external customers.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off (PTO)
• Incentive bonus programs
• Medical insurance
• Dental insurance
• Vision insurance
• Short and long term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 11-50 employees