Investigator Senior
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Nashville, TN, USA, Mason, OH, USA, Seven Hills, OH, USA, Columbus, OH, USA, Cincinnati, OH, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
Requirements
- Requires a BA/BS and minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement; or any combination of education and experience, which would provide an equivalent background.
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.
- Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and/or state.
- May interface internally with Senior level management and legal department throughout investigative process.
- May assist in training of internal and external entities.
- Assists in the development of policy and/or procedures to prevent loss of company assets.
- May be called upon to represent the Company in court proceedings regarding research findings.
- Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts.
Preferred Qualifications
- Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred.
- Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.