SIU Investigator

Centene
Arkansas
Workplace: RemoteFull timeUSD 56,200 - 101,000 annuallyFunction: Data Analytics & Business IntelligenceExperience: 1+ yearsEducation: bachelorsSkills: ["Data analysis","Investigation","Reporting","Critical thinking","Communication"]

Investigate allegations of healthcare fraud and abuse, planning and executing claims investigations or audits to identify, evaluate, and measure potential fraud. Conduct investigations of waste, abuse and fraud; perform data mining to detect aberrancies in claims; develop queries and reports; coordinate with Health Plans and prepare investigative findings for referral to Federal and State agencies.

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FursaFursa
Centene
Centene
2 months ago

SIU Investigator

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 15 days agoStatus: Live

Job Summary

Investigate allegations of healthcare fraud and abuse, planning and executing claims investigations or audits to identify, evaluate, and measure potential fraud. Conduct investigations of waste, abuse and fraud; perform data mining to detect aberrancies in claims; develop queries and reports; coordinate with Health Plans and prepare investigative findings for referral to Federal and State agencies.
Location: Arkansas
Workplace: Remote
Employment Type: Full time
Job Function: Data Analytics & Business Intelligence
Seniority: Entry level

Key Responsibilities

  • •Investigate allegations 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

Pay and Benefits

Salary: USD 56,200 - 101,000 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience
  • •1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation
Experience:1+ yearsHealthcare
Education:Bachelor's
Skills:Data analysisInvestigationReportingCritical thinkingCommunication
Tech Stack:SQLData miningClaims analysis

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn