Anthem Inc. Marketing Jobs

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Anthem, Inc. Investigator II in Cary, North Carolina

Description

SHIFT: Day Job

SCHEDULE: Full-time

Investigator II

This position can be located anywhere and the preference is within an hour of NYC and willing to travel to the five boroughs of NYC.

Responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims.

Primary duties may include, but are not limited to:

  • 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.

  • Must be able to effectively establish rapport and on-going 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.

  • Health insurance, law enforcement experience preferred.

Qualifications

  • Requires BA/BS degree, 3+ years related experience; or any combination of education and experience, which would provide an equivalent background.

  • 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.

  • Healthcare fraud experience is strongly preferred.

  • Data mining experience is preferred.

  • Preferred location is in NYC and be located within one hour.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS49518-North%20Carolina

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