SIU Investigator at Centene

**Who this is for** This role is suited for a diligent and analytical individual with a keen interest in uncovering and preventing healthcare fraud and abuse. I

Work type: remote

Location: Remote-LA

Salary: $56,200 – $101,000/yr

Type: Full-time

Summary

**Who this is for** This role is suited for a diligent and analytical individual with a keen interest in uncovering and preventing healthcare fraud and abuse. If you possess strong investigative skills and a background in analyzing claims data, this remote position in Louisiana is an excellent opportunity. **Key highlights** You will be responsible for conducting thorough investigations into potential healthcare fraud and abuse, contributing to the financial health and integrity of the organization. This position offers a competitive salary and the convenience of a fully remote work arrangement. **You might be a good fit if you...** - Hold a Bachelor's Degree in a relevant field or possess equivalent experience. - Have at least 1 year of experience in medical claim investigation, audit, or analysis. - Are adept at performing data mining to identify anomalies in claims. - Can effectively document findings and collaborate with various stakeholders.

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: this is a remote role, however, it requires Louisiana residency.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


• 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation 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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