SIU Investigator at Centene

Ideal for a professional with a Bachelor’s degree and at least three years of dedicated experience investigating Medicaid fraud, waste, and abuse within the Ken

Work type: remote

Location: Remote-KY

Salary: $56,200 – $101,000/yr

Type: Full-time

Summary

Ideal for a professional with a Bachelor’s degree and at least three years of dedicated experience investigating Medicaid fraud, waste, and abuse within the Kentucky Medicaid Program. You must be currently based in Kentucky to be considered for this opening. **What makes it worth a look...** Centene offers a competitive salary range of $56,200 to $101,000 per year for this fully remote role based in Kentucky. You will also have access to comprehensive benefits including 401K plans, tuition reimbursement, and stock purchase programs. **You might be a good fit if you...** * Possess deep expertise in the Kentucky Medicaid regulatory landscape. * Excel at data mining and identifying outliers in complex claims data. * Know how to build and maintain sophisticated audit queries. * Can translate investigative findings into formal reports for state and federal agencies.

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.
 

Please note: Candidates must reside within the state of Kentucky.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.

• Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required


• Minimum of three (3) years Medicaid fraud, waste and abuse investigatory experience located in Kentucky dedicated 100% to the Kentucky Medicaid Program required

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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