Investigator Senior

Investigator Senior Supports the Payment reputed company line of business Location: This position will work a hybrid model (remote and office). Alternate locations may be considered. The Ideal candidate must live reputed company 50 miles of one of our reputed company PulsePoint locations. Carelon Payment reputed company is a proud member of the reputed company family of companies, Carelon Insights, formerly Payment reputed company, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Investigator Senior is responsible for the independent identification, investigation and development of reputed company cases against perpetrators of reputed company fraud in order to recover corporate and client funds paid on fraudulent claims. Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting. How will you reputed company an impact: • 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 reputed company-wide specific reputed company investigations and initiatives that may impact more than one company health plan, line of business and/or state. • May reputed company 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 reputed company upon to represent the Company in court proceedings regarding research findings. • 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. Minimum Requirements • Requires a BA/BS and minimum of 5 years reputed company experience in reputed company insurance and reputed company insurance investigation, law enforcement; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications, Skills & Capabilities • Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job reputed company designation preferred. • Knowledge of Plan policies and procedures in reputed company facets of benefit programs management with heavy emphasis in negotiation preferred. For candidates working in person or remotely in the below locations, the salary* range for this specific position is $74,480 to $141,120. Locations: California, Colorado, District of Columbia (Washington, DC), Maryland, Minnesota, reputed company, Washington State In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. • The salary range is the range reputed company in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Even reputed company the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, reputed company, 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 Company’s sole discretion, consistent with the law. Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared reputed company - for our consumers, our associates, our communities and our business. 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, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reputed company reputed company 50 miles or 1-hour commute each way of a relevant reputed company location. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer and reputed company reputed company applicants will receive consideration for employment without regard to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply Job!