Investigator I

Elevance Health; Tampa (FL); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Elevance Health is seeking an Investigator I to join our team, focusing on detecting fraud, abuse, and waste in healthcare claims. The role requires analyzing data, preparing reports, and communicating findings to management and providers.

Candidate will work within Elevance Health's hybrid workforce strategy, balancing virtual work with in-person onboarding and training sessions. A BA/BS and at least 2 years in related healthcare insurance roles are preferred.

Qualifications

Responsibilities

• Investigate assigned cases, collect, research and analyze claim data to detect fraudulent, abusive or wasteful activities/practices.
• Prepare statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.
• Prepare final case reports and notification of findings letters to providers.
• Receive offers of settlement for review and discussion with management.
• Communicate findings clearly to internal and external customers via oral and written channels.

Skills

Investigative experience

Data analysis

Excel pivot tables

CPT coding familiarity

Education

BA/BS in related field

Tools

SQL

Job description

Investigator I

Location:

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Investigator I is responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices.

How you will make an impact:

• Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers.

• Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.

• Preparation of final case reports and notification of findings letters to providers.

• Receive offers of settlement for review and discussion with management.

• Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings.

Minimum Requirements:

Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Investigative experience preferred (e.g. health insurance, law enforcement).

• Excel proficiency is strongly preferred; ability to run pivot tables and analyze large datasets.

• Familiarity with CPT coding preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - 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, 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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health 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.

The health of our associates and communities is a top priority for Elevance Health. We require all 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. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will 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. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).