SIU Investigator

Centene
Florida
Workplace: RemoteFull timeUSD 56,200 - 101,000 annuallyFunction: Finance & AccountingExperience: 1+ yearsEducation: bachelorsSkills: ["Communication","Problem-solving","Teamwork"]

Investigate allegations of healthcare fraud and abuse, assisting in planning, organizing, and executing claims investigations or audits to identify, evaluate, and measure potential fraud. Perform data mining to detect aberrancies in claims, develop queries, and coordinate with Health Plans. Prepare reports for referral to Federal and State agencies and assist with complex investigations.

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FursaFursa
Centene
Centene
2 months ago

SIU Investigator

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 13 days agoStatus: Live
Reposted: similar role first listed 4 months ago

Job Summary

Investigate allegations of healthcare fraud and abuse, assisting in planning, organizing, and executing claims investigations or audits to identify, evaluate, and measure potential fraud. Perform data mining to detect aberrancies in claims, develop queries, and coordinate with Health Plans. Prepare reports for referral to Federal and State agencies and assist with complex investigations.
Location: Florida
Workplace: Remote
Employment Type: Full time
Job Function: Finance & Accounting

Key Responsibilities

  • •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

Pay and Benefits

Salary: USD 56,200 - 101,000 annually
Perks:Health Insurance401kEquityRemote Work

Key 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
  • •Strong data mining and analysis skills for detecting aberrancies in claims
  • •Ability to develop new queries and reports to detect waste, abuse, and fraud
  • •Experience in preparing summaries and/or detailed reports for referral to Federal and State agencies
Experience:1+ yearsHealthcare fraudClaims investigationData mining
Education:Bachelor's
Skills:CommunicationProblem-solvingTeamwork
Languages:English
Tech Stack:Data miningSQLClaims 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