Investigator II
Elevance Health•Atlanta, VA
•Hybrid
About The Position
The Investigator II is responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims.
Requirements
- BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Nice To Haves
- 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.
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.
- Identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state.
- Establishing rapport and on-going working relationship with law enforcement.
- Interfacing internally with Senior level management and legal department throughout investigative process.
- Assisting in training of internal and external entities.
- Assisting in the development of policy and/or procedures to prevent loss of company assets.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
