SIU Investigator
Position Purpose
Investigate allegations of potential healthcare fraud and abuse activity.
Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.
Conduct investigations of potential waste, abuse, and fraud.
Document activity on each case and refer issues to the appropriate party.
Perform data mining and analysis to detect aberrancies and outliers in claims.
Develop new queries and reports to detect potential waste, abuse, and fraud.
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions or resolutions.
Assist with complex allegations of healthcare fraud.
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies.
Completes various special projects and audits.
Complies with all policies and standards.
Education/Experience
- Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience required.
- 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required.
Pay Range
$56,200.00 - $101,000.00 per year
Benefits
Competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Total compensation may also include additional forms of incentives.
Benefits may be subject to program eligibility.
About the Role
Centene is transforming the health of our communities, one person at a time.
As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Candidates who reside in Florida are highly preferred.
Qualifications
None specified.
Skills
Not specified.
Benefits
Not specified.
Schedule
Not specified.