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Investigator Sr (Us) Jobs
Company | Elevance Health |
Address | Washington, United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-07-31 |
Posted at | 10 months ago |
- Date Posted:Jun 29, 2023
- Req #: JR77640
- Type: Full time
- Job Family: Enterprise Operations
- National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
- NY, NEW YORK
- May be called upon to represent the Company in court proceedings regarding research findings.
- May assist in training of internal and external entities.
- 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.
- 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.
- 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.
- Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting.
- Assists in the development of policy and/or procedures to prevent loss of company assets.
- 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.
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