Investigator II

Investigator II Anticipated End Date: 2026-07-31 Location: VA – Norfolk, IN – Indianapolis, IA – Des Moines, TN – Nashville, LA - Metairie. Hybrid: This role requires associates to be in‑office 1‑2 days per week with flexibility for virtual work, fostering collaboration while supporting productivity and work‑life balance. Alternate locations may be considered if candidates reside within commuting distance from an office. Candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law. Roles & Responsibilities Identify, investigate, and develop cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. Conduct claim reviews for appropriate coding, data mining, entity review, law‑enforcement referral, and use proprietary data and claim systems for reviews of facility, professional, and pharmacy claims. Identify and develop enterprise‑wide investigations that may impact multiple company health plans, lines of business, or states. Establish rapport and maintain ongoing working relationships with law‑enforcement agencies. Interface with senior management and legal departments throughout investigative processes. Assist in training internal and external entities. Develop policy and procedures to prevent loss of company assets. Minimum Qualifications BA/BS degree and minimum 3 years of related experience; or equivalent combination of education and experience. Preferred Qualifications & Skills Fraud certification from CFE, AHFI, or AAPC, or related coding certificates. Knowledge of plan policies and procedures across all facets of benefit program management with emphasis on negotiation. Experience in health insurance and law‑enforcement. Job Details Job Level: Non‑Management Exempt Work Shift: Based on location Job Family: FRD – Investigation Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources. Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer. 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, or local laws. #J-18808-Ljbffr