Investigator Senior

Elevance Health • Walnut Creek, CA

390d • $77,028 - $132,048

About The Position

The Investigator Senior role at Elevance Health is focused on supporting the Payment Integrity line of business by independently identifying, investigating, and developing complex cases related to healthcare fraud. This position aims to recover corporate and client funds lost to fraudulent claims, requiring a strong background in health insurance and investigative processes.

Requirements

• BA/BS degree and a minimum of 5 years of experience in healthcare insurance and investigation or law enforcement.
• Strong understanding of health insurance policies and claims handling.

Nice To Haves

• Professional certification such as CFE, AHFI, CPC, Paralegal, RN, JD, or other related designations.
• Knowledge of plan policies and procedures in benefit program management with an emphasis on negotiation.
• Bilingual in Spanish.

Responsibilities

• Conduct claim reviews for appropriate coding and data mining.
• Independently identify and develop healthcare investigations that may impact multiple health plans or states.
• Interface with senior management and legal departments during investigations.
• Assist in training internal and external entities.
• Develop policies and procedures to prevent loss of company assets.
• Represent the company in court regarding research findings.
• Maintain rapport with law enforcement and regulatory agencies to assist in investigations.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, and vision insurance
• Short and long-term disability benefits
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

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