Elevance Health
Investigator II
GA-ATLANTA, 740 W PEACHTREE ST NW, USA · Mid · Full-time
Sponsorship not specifiedDetected 5 hours ago
AccessibilityNegotiationExcelHRIS
Stay score
odds of building a lasting career here
42Risky
Cap-exempt (no lottery)0
Sponsors this role100
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70
Thin sponsorship signal and lottery-bound. A low-probability bet with your clock running. Prioritize cap-exempt roles and proven entry-level sponsors first.
Lottery odds assume a STEM candidate.
Personalize to your clock →Employer immigration record
from this employer's Department of Labor filings
Files H-1B transfers
2 transfer filings in the last year, covering 2 workers. Median labor-condition decision: 122 days. An employer that already files transfers is one that can take over an existing H-1B.
Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.
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About the role
- 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.
- Effectively establish rapport and on-going working relationship with law enforcement.
- May interface internally with Senior level management and legal department throughout investigative process.
Requirements
- Requires a BA/BS and minimum of 3 years related experience
- Advanced Excel proficiency
- ability to run pivot tables and analyze large datasets.
Nice to have
- Preferred Skills, Capabilities and Experiences:
Skills
- Advanced Excel proficiency; ability to run pivot tables and analyze large datasets.
- Familiarity with CPT coding.
- 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.
- Investigative experience preferred (e.g. health insurance, law enforcement).
Compensation
- Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.
Benefits
- Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company's health plan, line of business and/or state.
- The Investigator II is 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.
Company info
- Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
- How We Work
- At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
- 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.
- Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler.
- We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
- At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
- Our values and behaviors are the root of our culture.
- They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
- Elevance Health operates in a Hybrid Workforce Strategy.
- Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
- Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
- The health of our associates and communities is a top priority for Elevance Health.
- We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza.
Visa & Work Authorization
- ent Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gend
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This listing is sourced directly from Elevance Health's careers page and normalized into a canonical job model.