Investigator Senior

Company: Anthem, Inc
Location: Grand Prairie
Posted on: May 3, 2021

Job Description:

Description SHIFT: Day Job SCHEDULE: Full-time Investigator Senior This position will be a remote role. Responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. Primary duties may include, but are not limited to: + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. + Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and/or state. + May interface internally with Senior level management and legal department throughout investigative process. + May assist in training of internal and external entities. + Assists in the development of policy and/or procedures to prevent loss of company assets. + May be called upon to represent the Company in court proceedings regarding research findings. + Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting. + Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts. Qualifications + Requires BA/BS degree 5+ years related experience in healthcare insurance and healthcare insurance investigation, law enforcement or any combination of education and experience which would provide an equivalent background. + Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred. + Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.Applicable to Colorado Applicants OnlyAnnual Salary Range: $71,040 - $88,800 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at . An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER: PS49523-Texas

Keywords: Anthem, Inc, Grand Prairie , Investigator Senior, Other , Grand Prairie, Texas