Investigator II

Investigator II Location: Hybrid1: This role requires associates to be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. How you will make an impact Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state. Effectively establish rapport and ongoing working relationship with law enforcement. May interface internally with senior‑level management and legal department throughout investigative process. May assist in training of internal and external entities. Assists in the development of policy and/or procedures to prevent loss of company assets. Minimum Requirements Requires a BA/BS and a minimum of 3 years related experience; or any combination of education and experience that would provide an equivalent background. Preferred Skills, Capabilities, and Experiences Fraud certification from CFE, AHFI, AAPC or coding certificates preferred. Knowledge of plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred. Health insurance, law enforcement experience preferred. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Elevance Health