Centene
Healthcare
SIUInvestigator
Neural analysis suggests this role is
optimal for Mid candidates.
“SIU Investigator at Centene. Skills: fraud investigations, abuse investigations, waste investigations, claims analysis, audit preparation. 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”
Industry & Context.
Investigate allegations; detect aberrancies and outliers in claims; Develop new queries and reports to detect potential waste, abuse, and fraud
What They're Looking For.
Must Have
Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required, 5+ years in healthcare field working in fraud, waste and abuse investigations and audits, 5+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, 7+ years of professional investigation experience involving economic or insurance related matters
Nice to Have
Candidates residing in the state of New York are highly preferred
What You'll Do.
Investigate allegations of potential healthcare fraud and abuse activity
and executing claims investigations or audits that identify
evaluate and measure potential healthcare fraud and abuse
Conduct investigations of potential waste
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
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
How You'll Work.
Team & Collaboration
coordinate with Health Plans on recommendations and further actions and/or resolutions
Communication Scope
Provide case updates on progress of investigations; Prepare summary and/or detailed reports on investigative findings
Process & Methodology
planning, organizing, executing claims investigations or audits, special projects
Full Job Description
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. **Candidates residing in the state of New York are highly preferred.** **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 Business, Criminal Justice, Healthcare, or related field, or equivalent experience required * 5+ years in healthcare field working in fraud, waste and abuse investigations and audits, (or) 5+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) 7+ years of professional investigation experience involving economic or insurance related matters 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, pai
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