SIU Investigator

Centene Corporation

17h•Remote

About The Position

Centene is transforming the health of its communities, serving 28 million members. This remote SIU Investigator role, which requires Louisiana residency, is dedicated to investigating allegations of potential healthcare fraud and abuse activity. The position involves assisting in the planning, organizing, and execution of claims investigations or audits to identify, evaluate, and measure potential healthcare fraud and abuse.

Requirements

Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Responsibilities

Investigate allegations of potential healthcare fraud and abuse activity
Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse
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
Performs other duties as assigned
Complies with all policies and standards