Special Investigation Unit Investigator

Centene; United States; Remote; USD 55,000 - 99,000; Full time

Job summary

Centene is seeking an Investigator to conduct healthcare fraud investigations. The role involves analyzing claims data, documenting findings, and collaborating with health plans. A Bachelor's degree and relevant experience are required. Join a leading organization committed to transforming healthcare for millions.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 1+ years of medical claim investigation or fraud investigation experience.
• Experience in medical claim audit or analysis is a plus.

Responsibilities

• Conduct investigations of potential waste, abuse, and fraud.
• Document activity on each case and refer issues appropriately.
• Prepare detailed reports on investigative findings.

Skills

Investigation

Data Analysis

Documentation

Education

Bachelor’s Degree in Business, Criminal Justice, Healthcare

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• Perform data mining and analysis to detect aberrancies and outliers in claims
• Develop new queries and reports to detect potential waste, abuse, and fraud
• Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
• Assist with complex allegations of healthcare fraud
• Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
• Complete various special projects and audits
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

About the company

Centene Corporation is a publicly traded managed care company based in St. Louis.

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