Investigator II - Behavioral Health

Investigator II – Behavioral Health

Anticipated End Date: .

Location:

Hybrid – associates are required to work from an Elevance Health location 1–2 days per week, with additional remote work allowed.

• Identify, investigate, and develop cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims.
• Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use proprietary data and claim systems for review of facility, professional, and pharmacy claims.
• Develop and carry out enterprise-wide investigations that may impact multiple company health plans, lines of business, and/or states.
• Establish and maintain a working relationship with law enforcement agencies throughout the investigative process.
• Interface with senior management and the legal department as needed.
• Assist in training internal and external stakeholders on fraud detection and prevention.
• Help develop policies and procedures to prevent loss of company assets.

• BA/BS degree and a minimum of 3 years of related experience, or an equivalent combination of education and experience.
• Fraud certification from CFE, AHFI, AAPC or coding certifications preferred.
• Knowledge of plan policies and procedures in all facets of benefit program management, with emphasis on negotiation.
• Experience in health insurance and law enforcement preferred.

Salary range: $67,640 – $101,460. Position located in Virginia.

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution with match.

Elevance Health is an Equal Employment Opportunity employer. All qualified applicants receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.