Investigator II at Elevance Health

St Louis, Missouri, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Insurance, MedicaidIndustries

Requirements

Bachelor's degree (BA/BS) in any field
Minimum of 3 years of related experience
Healthcare experience strongly preferred
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation
Healthcare experience
Advanced Data analysis experience
Strongly preferred: Advanced Microsoft Excel experience
Healthcare insurance
Law enforcement experience

Responsibilities

Identify and develop cases against perpetrators of healthcare fraud
Investigate and review claims for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems
Establish rapport and on-going working relationship with law enforcement
Interface internally with Senior level management and legal department throughout investigative process
Assist in training of internal and external entities
Develop policy and/or procedures to prevent loss of company assets
Assist in the development of policy and/or procedures to prevent loss of company assets
Provide training to internal and external entities
Interface with law enforcement and other stakeholders
Develop and maintain relationships with law enforcement agencies
Conduct data analysis and review of claims
Develop and implement policies and procedures to prevent loss of company assets

Skills

Key technologies and capabilities for this role

healthcare fraud investigationclaim reviewdata miningcoding reviewlaw enforcement liaisondata analysis

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week in St. Louis, MO, while providing flexibility for virtual work to support productivity and work-life balance.

What are the required qualifications for the Investigator II position?

The role requires a BA/BS and a minimum of 3 years of related experience, or any combination of education and experience that provides an equivalent background.

What preferred skills or experiences are highlighted for this job?

Preferred qualifications include residing in Missouri, healthcare experience, fraud certifications (CFE, AHFI, AAPC or coding certificates), knowledge of plan policies, health insurance or law enforcement experience, and advanced data analysis and Microsoft Excel skills.

What is the company culture like at Elevance Health?

Elevance Health fosters a culture designed to advance strategy while promoting personal and professional growth, rooted in core values and behaviors, with a dynamic workplace that balances office collaboration and virtual flexibility.

What makes a strong candidate for this Investigator II role?

Strong candidates will have a BA/BS with 3+ years of related experience, reside in Missouri, and bring healthcare or fraud investigation background, along with advanced Excel, data analysis skills, and relevant certifications.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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