SIU Investigator

*Please note: Candidates must reside within the state of California* 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. Key Responsibilities 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 Perform other duties as assigned Comply with all policies and standards Education & Experience Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience required. Pay Range: $56,200.00 - $101,000.00 per year Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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. Location Topanga, CA Equal Employment Opportunity 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. #J-18808-Ljbffr Centene