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Investigator II

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Elevance Health

Aug 2, 2024

Applications are closed

  • Job
    Full-time
    Mid-level (3-4 years)
  • Tampa

Requirements

  • Minimum Requirements
  • Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
  • Preferred Skills, Capabilities, And Experiences
  • 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.
  • Excel knowledge a plus.
  • Experience within Managed Care Organization a plus.

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 identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state.
  • Effectively establish rapport and on-going working relationship with law enforcement.
  • 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.

FAQs

Do we support remote work?

Yes, we support remote work in a hybrid format, requiring in-office presence 1-2 times per week.

What is the primary focus of the Investigator II position?

The primary focus of the Investigator II position is to identify, investigate, and develop cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims.

What are the minimum requirements for this position?

The minimum requirements for this position include a BA/BS degree and a minimum of 3 years of related experience, or any combination of education and experience that provides an equivalent background.

Is prior certification preferred for candidates?

Yes, professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or other job-related designations are preferred.

What kind of experience is beneficial for this position?

Experience within a Managed Care Organization is considered a plus for this position.

How often is the Investigator II position expected to interact with law enforcement?

The Investigator II is expected to effectively establish rapport and maintain an ongoing working relationship with law enforcement throughout the investigative process.

What is the salary range for the Investigator II position?

The salary range for this position is $70,980 to $116,610, depending on various factors including geographic location, work experience, education, and skill level.

Are there benefits associated with this position?

Yes, Elevance Health offers a comprehensive benefits package, including equity stock purchase, 401k contribution, incentive and recognition programs, among others, subject to eligibility requirements.

Where should candidates ideally reside for this position?

The ideal candidate should live within 50 miles of one of our Elevance Health PulsePoint locations.

What types of investigations will the Investigator II be responsible for?

The Investigator II will be responsible for identifying and developing enterprise-wide healthcare investigations that may impact multiple health plans, lines of business, or states.

Improving the health of humanity

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.   Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.