SIU Investigator at Centene

**Who this is for** This position is for a sharp, investigative mind with a strong understanding of healthcare operations and a commitment to combating fraud an

Work type: remote

Location: Remote-NY

Salary: $56,200 – $101,000/yr

Type: Full-time

Summary

**Who this is for** This position is for a sharp, investigative mind with a strong understanding of healthcare operations and a commitment to combating fraud and abuse. If you have a background in investigations, a knack for data analysis, and a desire to protect the integrity of healthcare systems, this role is for you. **Key highlights** You will be at the forefront of investigating allegations of healthcare fraud and abuse, playing a vital role in identifying, evaluating, and mitigating potential financial and operational risks. This is a fully remote opportunity for candidates in New York. **You might be a good fit if you...** - Have a Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience. - Possess 5+ years of experience in healthcare fraud, waste, and abuse investigations, or equivalent investigative experience. - Are skilled in data mining and analysis to detect suspicious patterns in claims. - Can effectively document findings and prepare reports for referral to regulatory 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.
 

Candidates residing in the state of New York are highly preferred.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


• 5+ years in healthcare field working in fraud, waste and abuse investigations and audits, (or) 5+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) 7+ years of professional investigation experience involving economic or insurance related matters

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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