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Elevance Health
Elevance Health
H1B vīzas sponsorsB2BVeselības apdrošināšanaVeselības aprūpe
Elevance Health ir veselības aprūpes un veselības apdrošināšanas uzņēmums, kas veido plašāku un ilgtermiņa pieeju cilvēku veselības atbalstam. Uzņēmuma darbība apvieno veselības pabalstus, integrētus visaptverošas veselības aprūpes pakalpojumus un digitālās veselības iespējas, lai efektīvāk sasaistītu aprūpi un apdrošināšanas segumu. Ar gandrīz 100 000 darbinieku un vairāk nekā 118 miljoniem apkalpotu cilvēku Elevance Health piedāvā amatus lielā, daudznozaru organizācijā, kas koncentrējas uz veselības rezultātu uzlabošanu, veselības aprūpes sistēmas attīstību un stiprāku kopienu atbalstīšanu.
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Vakances uzņēmumā

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.

USAmerikas Savienotās ValstisFLFloridaTXTeksasaHibrīdiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuIzmeklētājsVispārīgi

Apraksts

  • 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

Prasības

  • 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

Priekšrocības

  • 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

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