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Elevance Health
Elevance Health
Sponsor pentru viza H1BAsigurare de sănătateAsistență medicalăB2B
Elevance Health este o companie de servicii medicale și asigurări de sănătate care dezvoltă o abordare mai amplă și pe termen lung pentru sprijinirea sănătății oamenilor. Activitatea sa combină beneficiile medicale, serviciile integrate pentru sănătatea întregii persoane și capacitățile de sănătate digitală, concepute pentru a conecta mai eficient îngrijirea medicală cu acoperirea de asigurare. Cu o echipă de aproape 100.000 de angajați care deservește peste 118 milioane de persoane, Elevance Health oferă roluri într-o organizație mare și multidisciplinară, concentrată pe îmbunătățirea rezultatelor în materie de sănătate, evoluția sistemului de sănătate și sprijinirea unor comunități mai puternice.
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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.

USStatele Unite ale AmericiiFLFloridaTXTexasHibridNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăGeneralInvestigator

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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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