Investigator I
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Mason, OH, USA, Norfolk, VA, USA, Atlanta, GA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Junior, Mid Level |
Requirements
- Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.
Responsibilities
- Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers.
- Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.
- Preparation of final case reports and notification of findings letters to providers.
- Receive offers of settlement for review and discussion with management.
- Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings.
Preferred Qualifications
- Advanced Microsoft Office experience preferred
- Prior Healthcare Fraud Investigation experience preferred