SIU Investigator

Position Purpose

You could be the one who changes everything for our 28 million members. 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.

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
• Strong Excel skills preferred
• CFE (Certified Fraud Examiner) preferred

Qualifications

• Complies with all policies and standards

Skills

• None specified

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

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

Schedule

• Total compensation may also include additional forms of incentives
• Benefits may be subject to program eligibility