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Elevance Health
Elevance Health
H1B vizos rėmėjasB2BSveikatos draudimasSveikatos priežiūra
„Elevance Health“ yra sveikatos priežiūros ir sveikatos draudimo bendrovė, kurianti platesnį ir ilgalaikį požiūrį į žmonių sveikatos palaikymą. Jos veikla apima sveikatos išmokas, integruotas visapusiškos sveikatos paslaugas ir skaitmeninės sveikatos sprendimus, skirtus veiksmingiau susieti priežiūrą ir draudimo apsaugą. Beveik 100 000 darbuotojų turinti ir daugiau nei 118 milijonų žmonių aptarnaujanti „Elevance Health“ siūlo galimybes didelėje, įvairių sričių organizacijoje, kurios tikslas – gerinti sveikatos rezultatus, tobulinti sveikatos priežiūros sistemą ir stiprinti bendruomenes.
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Healthcare Fraud Investigator II

Investigate healthcare fraud, review claims, and recover funds for Elevance Health plans and clients. Build cases using claims data and work with law enforcement, legal teams, and internal stakeholders.

USJungtinės ValstijosFLFloridaTXTeksasasHibridinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųBendraTyrimų specialistas

Aprašymas

  • Investigate suspected healthcare fraud and develop cases against perpetrators
  • Recover company and client funds paid on fraudulent claims
  • Review claims for coding accuracy, data mining, entity review, and potential law enforcement referral
  • Analyze facility, professional, and pharmacy claims using proprietary data and systems
  • Develop enterprise-wide investigations that may affect multiple health plans, business lines, or states
  • Build and maintain working relationships with law enforcement
  • Coordinate with senior management and the legal department throughout investigations
  • Help train internal and external groups
  • Help develop policies and procedures to prevent company asset losses

Reikalavimai

  • Bachelor’s degree and at least three years of related experience, or an equivalent combination of education and experience
  • Advanced Excel skills, including pivot tables and analysis of large datasets
  • Familiarity with CPT coding
  • CFE, AHFI, AAPC fraud certification, or coding certification preferred
  • Knowledge of health plan policies and benefit program management, particularly negotiation, preferred
  • Investigative experience, such as in health insurance or law enforcement, preferred
  • Must live within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law
  • For certain patient- or member-facing roles, new hires must receive COVID-19 and influenza vaccinations unless they provide an acceptable explanation

Privalumai

  • Merit pay increases
  • Paid holidays
  • Paid time off
  • Incentive bonus programs
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Short-term disability coverage
  • Long-term disability coverage
  • 401(k) plan with matching contributions
  • Employee stock purchase plan
  • Life insurance
  • Wellness programs
  • Financial education resources
  • Full-time virtual work arrangement, with in-person attendance required for training sessions

Susiję darbai

FVI School of Nursing and Technology

Clinical Coordinator – Nursing Student Placements

FVI School of Nursing and Technology
51 – 200 Darbuotojai
B2CSveikatos priežiūraŠvietimas
USJungtinės ValstijosFLFloridaHibridinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųBendraKlinikinis koordinatorius

Coordinate clinical placements, schedules, records, and compliance for nursing students in Miramar and Miami. Work with clinical partners, faculty, students, and nursing leadership to support program requirements.

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