Investigator Senior supports the Payment Integrity line of business. This role enables associates to work virtually full-time, except for required in-person training sessions, providing flexibility and autonomy. The Investigator Senior is responsible for independent identification, investigation, and development of complex cases against healthcare fraud perpetrators to recover corporate and client funds paid on fraudulent claims. Requires health insurance experience with understanding of policies, claims handling, and provider network contracting. Responsibilities include claim reviews for coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for facility, professional, and pharmacy claims. Develops enterprise-wide healthcare investigations impacting multiple health plans, lines of business, or states. Interfaces with senior management and legal departments, assists in training, develops policies to prevent asset loss, may represent the company in court, and maintains cooperation with law enforcement and regulatory agencies. Minimum requirements include a BA/BS and 5 years related experience in healthcare insurance, investigation, or law enforcement. Preferred certifications include CFE, AHFI, CPC, Paralegal, RN, JD, or related designations. Knowledge of plan policies and negotiation preferred. Salary range for in-person or virtual candidates in specified states is $82,320 to $141,120, with additional benefits including incentive programs, equity stock purchase, and 401k contributions. Elevance Health is committed to equal pay and equal employment opportunity.
By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Sonicjobs Privacy Policy at and Terms & Conditions at and SonicJobs Privacy Policy at and Terms of Use at
I am currently looking for a MuleSoft developer for one of my clients. You'll be tasked with technical design and development of custom, functional solutions within the MuleSoft platform. You will lead the configuration and coding on the MuleSoft platform, working/directing...
...for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident... ...experiences and extraordinary medicine for adults, newborns, teens, and children. We offer some of the most advanced treatment choices...
~ Associate investigator focusing on panel and wafer-level processing techniques, comfortable with exploring advanced/non-standard methods for unique applications ~ Adept at hands-on lab work, creative thinking, problem solving in a unique and fast-paced laboratory environment...
...how we show up, everywhere & always. Want in? Join the #VTeamLife. What youll be doing... As an Information System Security Officer (ISSO) for one of our Public Sector teams, you will bring your passion, education and experience to the critical task of managing...
...Certifications: None Experience: 2 + years of related experience US Citizenship Required: Yes Job Description: Electronics Technician Maintenance II As an Electronics Technician, you will: Read and interpret wiring diagrams, wiring tables, and...