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Investigator Ii - Elevance Health
Company | Elevance Health |
Address | Middletown, NJ, United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-07-26 |
Posted at | 10 months ago |
Investigator II
- Job Family: Enterprise Operations
- Type: Full time
- Req #: JR74296
- Date Posted:Jun 08, 2023
- New York, Garden City
- Connecticut, Bridgeport
- New York, Manhattan
- Connecticut, Norwalk
- New York, Bronx
- New Jersey, Morristown
- Connecticut, New Haven
- New Jersey, Iselin
- New York, Queens
- New York, Brooklyn
- Connecticut, Danbury
- New York, New York City
- New York, Middletown
- New York, Long Island
- Connecticut, Stamford
- New Jersey, Middletown
- Pennsylvania, Philadelphia
- Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claims 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 ongoing working relationships with law enforcement. May interface internally with Senior level management and legal department throughout the investigative process.
- May assist in the training of internal and external entities. Assists in the development of policies and/or procedures to prevent loss of company assets.
- Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
- Fraud certification from CFE, AHFI, AAPC, or coding certificates preferred.
- Knowledge of Plan policies and procedures in all facets of benefit programs management with a heavy emphasis on negotiation preferred. Health insurance, and/or law enforcement experience preferred.
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
- Pay Transparency
- EEO Policy Statement
- Know Your Rights
- Privacy Notice for California Residents
-
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