SIU Investigator

🕒 6 days ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

✨ Investigator

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• 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 • 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 • Performs other duties as assigned. Complies with all policies and standards.

🎯 Requirements

• Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience required • 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules