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Elevance Health
Elevance Health
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Elevance Health insonlar salomatligini qo‘llab-quvvatlashga kengroq va uzoq muddatli yondashuvni shakllantirayotgan sog‘liqni saqlash va tibbiy sug‘urta kompaniyasidir. Uning faoliyati tibbiy sug‘urta imtiyozlari, salomatlikka yaxlit yondashuvni ta’minlaydigan integratsiyalashgan xizmatlar hamda tibbiy yordam va sug‘urta qamrovini yanada samarali bog‘lash uchun yaratilgan raqamli sog‘liqni saqlash imkoniyatlarini birlashtiradi. Qariyb 100 000 nafar xodimi 118 milliondan ortiq kishiga xizmat ko‘rsatayotgan Elevance Health sog‘liq natijalarini yaxshilash, sog‘liqni saqlash tizimini rivojlantirish va yanada kuchli hamjamiyatlarni qo‘llab-quvvatlashga e’tibor qaratadigan katta, ko‘p yo‘nalishli tashkilotda turli lavozimlarni taklif etadi.
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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.

USAmerika Qo‘shma ShtatlariFLFloridaTXTexasGibridTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaTergovchiUmumiy

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

  • 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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