Remote Healthcare Fraud Investigator I Data Analytics

The Elevance Health Companies, Inc.; Atlanta (GA); Hybride; USD 60 000 - 80 000; Plein temps

Résumé du poste

Elevance Health in the United States is seeking an Investigator I to join our FRD > Investigation team. This role supports virtual work with required in-person training and onboarding, focusing on analyzing claim data to detect fraudulent, abusive or wasteful activities, while maintaining compliant case files.

You will use system tools to review professional and facility claims, prepare statistical analyses, and draft findings letters.

Qualifications

• 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.
• 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.

Responsabilités

• 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.

Connaissances

Attention to detail

Analytical thinking

Communication skills

Excel proficiency

Formation

BA/BS degree

Outils

Excel

Description du poste

Elevance Health in the United States is seeking an Investigator I to join our FRD > Investigation team. This role supports virtual work with required in-person training and onboarding, focusing on analyzing claim data to detect fraudulent, abusive or wasteful activities, while maintaining compliant case files.

You will use system tools to review professional and facility claims, prepare statistical analyses, and draft findings letters.