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.

Responsibilities

• 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 and/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
• Complete various special projects and audits

Requirements

• 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
• Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, or five years of insurance claims investigation experience, or seven years of professional investigation experience involving economic or insurance related matters

Qualifications

• Complies with all policies and standards

Benefits

Centene offers a comprehensive benefits package including: 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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Pay

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Schedule

Centene offers a flexible approach to work with remote, hybrid, field or office work schedules.