Elevance Health
Elevance Health
Elevance Health is a healthcare and health insurance company building a broader, long-term approach to supporting people’s health. Its work combines health benefits, integrated whole-health services, and digital health capabilities designed to connect care and coverage more effectively. With a workforce of nearly 100,000 associates serving more than 118 million people, Elevance Health offers roles across a large, multidisciplinary organization focused on improving health outcomes, evolving the healthcare system, and supporting stronger communities.

Clinical Provider Auditor II - Grand Prairie Hybrid

Review claims and medical records for coding compliance, fraud, waste, and abuse risks. Support investigations, recommend loss-control measures, and help strengthen healthcare claim controls.

Description

  • Assess issues and entities that may present fraud and abuse risks
  • Evaluate claims against applicable billing and processing requirements
  • Identify opportunities to prevent and control fraud and abuse
  • Review claims and medical records before payment
  • Record determinations accurately in required systems and advance claims through the appropriate lifecycle stage
  • Research healthcare-related questions that support investigations
  • Monitor developments in medical coding, billing, laws, and regulations
  • Partner with the Special Investigation Unit and other internal teams on shared concerns
  • Recommend loss-control and risk-avoidance actions based on investigation findings
  • Help train newly hired associates

Requirements

  • Associate degree or at least three years of medical coding or auditing experience, including at least one year focused on fraud, waste, and abuse; an equivalent combination of education and experience may also qualify
  • Active coding certification such as CPC, CCS, or CPMA
  • Working knowledge of ICD-10 and CPT/HCPCS coding guidelines and terminology
  • Must live within a reasonable commuting distance of the listed posting location unless a legally required accommodation applies
  • New hires in certain patient- or member-facing positions must receive COVID-19 and influenza vaccinations unless an acceptable explanation is provided

Benefits

  • Comprehensive benefits coverage
  • Incentive and recognition programs
  • Employee stock purchase opportunity
  • 401(k) contributions
  • Merit-based pay increases
  • Paid holidays
  • Paid time off
  • Incentive bonus opportunities
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Short-term disability coverage
  • Long-term disability coverage
  • 401(k) plan with matching
  • Stock purchase plan
  • Life insurance
  • Wellness initiatives
  • Financial education resources
  • Flexible virtual work options
  • Required in-person training sessions
  • Professional and personal development opportunities

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