Overview
Investigator Senior Jobs in Washington, District of Columbia, USA at Elevance Health
Anticipated End Date:
Position Title: Investigator Senior
Job Description:
Investigator Senior
Supports the Payment Integrity line of business
Location:
This position will work a hybrid model (remote and office). Alternate locations may be considered. The Ideal candidate must live within 50 miles of one of our Elevance Health PulsePoint locations.
Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
The Investigator Senior is responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting.
How will you make an impact:
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.
Minimum 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.
Preferred Qualifications, Skills & Capabilities
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.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $77,028 to $132,048.
Locations:
California;
Colorado;
District of Columbia (Washington, DC), Maryland;
Minnesota, Nevada, New York, Washington State.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
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Title: Investigator Senior
Company: Elevance Health
Location: Washington, District of Columbia, USA
Category: Healthcare, Law/Legal
