Investigator Senior

2 days ago Be among the first 25 applicants

Supports the Payment Integrity line of business . Hybrid 1 : This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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.

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.
• Independently identify and develop enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and / or state.
• Interface with Senior level management and legal department throughout investigative process.
• Assist in training of internal and external entities.
• Assist in development of policy and / or procedures to prevent loss of company assets.
• Represent the Company in court proceedings regarding research findings when required.
• Develop and maintain rapport with Federal, State and local law enforcement and regulatory agencies to assist investigative efforts.

Minimum Requirements

Preferred Qualifications, Skills & Capabilities

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $78,400 to $141,120.

Locations : California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, 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. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. Elevance Health is an Equal Pay employer and ensures equal pay opportunities for equal work irrespective of gender, race, or any other category protected by law.

Compensation & Policies

Please note that Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes submitted to hiring managers become the property of Elevance Health.

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company focused on making healthcare easier and more affordable for members and communities we serve.

Working At Elevance Health

We are building a culture that supports strategic objectives, personal and professional growth. Our hybrid workforce requires time onsite at an Elevance Health location, with specifics discussed during the hiring process. We provide market-competitive total rewards, including medical / dental / vision, 401(k) with match, stock purchase, paid holidays, paid time off, incentive programs, and wellness resources. We comply with health and safety requirements and applicable laws. Elevance Health is an Equal Employment Opportunity employer. We consider applicants without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, gender identity, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.

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