SIUInvestigator

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. ***Please note: Candidates must reside within the state of California*** **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. * Conduct investigations of potential waste, abuse, and fraud * Document activity on each case and refer issues to the appropriate party * Perform data mining and analysis to detect aberrancies and outliers in claims * Develop new queries and reports to detect potential waste, abuse, and fraud * Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions * Assist with complex allegations of healthcare fraud * Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies * Complete various special projects and audits * Performs other duties as assigned * Complies with all policies and standards **Education/Experience:** Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience required. Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and