feedback icon
Summary

Wed Oct 11, 2017 - 1 week ago

Login or Register to vew

1 Views, 0 Applications

Investigator I, II or Senior - US - #135078

/Your Talent. Our Vision./*At Anthem, Inc.,*it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will*drive the future of health care*.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

The*Investigator I, II or Senior* is responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices.

Primary duties may include, but are not limited to:
* Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers.
* Prepares statistical/financial analyses and reports to document findings and maintains up-to-date case files for management review.
* Prepare final report and notification of findings letter suitable for dissemination to provider and counsel.
* Presents providers offers for settlement to management and legal for approval.
* Communicates orally and in writing with all customers, internal and external, regarding findings.
* Assists in the development of policy and/or procedures to prevent loss of company assets.
* May assist in training of internal and external entities.
* Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts.
* May be called upon to represent the Company in court proceedings regarding research findings.


Investigator I:
* Requires a BA/BS degree, 1-3 years of experience in related industry; or any combination of education and experience, which would provide an equivalent background.
* Previous law enforcement experience preferred.
* Fraud certification from ACFE or NHCAA, RN or JD certification preferred.
* Experience with FBI or District Attorneys Office preferred.
* Knowledge of claims and benefits management in a managed care organization, familiarity with health care industry and issues, contracts, cost containment practices, and case management techniques preferred.
Investigator II:
* Requires BA/BS degree, 3-5 years related experience; or any combination of education and experience, which would provide an equivalent background.
* Prior experience working with FBI, HHS-OIG or Department of Justice, or prosecution experience preferred.
* Fraud certification from HIAA or NHCAA, RN or JD certification preferred.
* Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
Investigator Sr.
* Requires BA/BS degree, 5 or more years related experience; or any combination of education and experience, which would provide an equivalent background.
* Prior experience working with FBI, HHS-OIG or Department of Justice, or prosecution experience preferred.
* Fraud certification from HIAA or NHCAA, RN or JD certification preferred.
* Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

/This position will be hired into the Investigator job family and the level will be determined based on the experience of the candidate selected./


*/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./*


**Job** *Fraud*
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

**Title:** *Investigator I, II or Senior - US - #135078*

**Location:** *kentucky-Bowling Green*

**Requisition ID:** *135078*

loading...