Investigator I (US)

Investigator I (US)

Investigator I

Locations: Columbus, GA or Cincinnati, OH

Hybrid 1: This role requires associates to be in-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 if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, 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.

The Investigator I is responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices.

How you will make an impact:

• Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers.
• Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.
• Preparation of final case reports and notification of findings letters to providers.
• Receive offers of settlement for review and discussion with management.
• Communication skills, both oral and written, required for contact with all customers, internal and external, regarding findings.

Minimum requirements:

• Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Healthcare experience is strongly preferred.
• Prior insurance company experience is preferred.

Job Level: Non-Management Exempt