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Posted: Monday, February 5, 2018 12:19 PM

/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 atone of America's leading health benefits companies and a Fortune Top 50 Company.
The*Investigator I, II, or Senior*is responsible for the independent identification, investigation and development of complex 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 independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and/or state.
* 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.
* May be called upon to represent the Company in court proceedings regarding research findings.
* Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting.
* 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.
*Investigator I*
* Requires BA/BS degree, 2 years related experience in health insurance fraud investigations; or any combination of education and experience, which would provide an equivalent background.
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*Investigator II *
* Requires BA/BS degree, 3 years related experience in health insurance fraud investigations; 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.
*Investigator Sr. *
* Requires BA/BS degree 5 years related experience in health insurance fraud investigations; 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.
*/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 - Remote (PS1082)*
**Location:** *ohio-Akron*
**Requisition ID:** *PS1082*
Associated topics: crime scene, detective, fingerprint, inspector, investigate, investigation, investigative, investigator

Source: http://www.jobs2careers.com/click.php?id=4901314785.96


• Location: Akron/Canton

• Post ID: 58351352 akroncanton
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