SIU Investigator

Centene
Ohio, Michigan, Kentucky, Indiana
Workplace: RemoteFull time56,200 - 101,000 annuallyFunction: Data Analytics & Business IntelligenceExperience: 2+ yearsSkills: ["Communication","Problem-solving","Analytical thinking","Attention to detail","Collaboration"]

Investigate allegations of healthcare fraud and abuse, plan and execute claims investigations and audits, perform data mining to detect aberrancies in claims, and prepare findings for referral to Federal and State agencies. Collaborate with Health Plans, develop queries/reports, and complete special audits while adhering to policies and standards.

Loading

Loading job details...

Preparing the role view and application actions.

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: 15 days agoStatus: Live

Job Summary

Investigate allegations of healthcare fraud and abuse, plan and execute claims investigations and audits, perform data mining to detect aberrancies in claims, and prepare findings for referral to Federal and State agencies. Collaborate with Health Plans, develop queries/reports, and complete special audits while adhering to policies and standards.
Location: Ohio, Michigan, Kentucky, Indiana
Workplace: Remote
Employment Type: Full time
Job Function: Data Analytics & Business Intelligence

Key Responsibilities

  • •Investigate allegations of waste, abuse, and fraud in healthcare and document activity on each case.
  • •Plan, organize, and execute claims investigations or audits to identify, evaluate, and measure potential fraud and abuse.
  • •Perform data mining and analysis to detect aberrancies and outliers in claims and develop new queries/reports.
  • •Provide case updates and coordinate with Health Plans on recommendations and resolutions; assist with complex allegations of healthcare fraud.
  • •Prepare summary/detailed reports on investigative findings for referral to Federal and State agencies and complete various special projects and audits.

Pay and Benefits

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

Key Requirements

  • •Bachelor's degree, or an Associate's degree with an additional 2 years working on health care fraud, waste, and abuse investigations and audits in lieu of a Bachelors is required.
  • •A minimum of 2 years in a health care field working on fraud, waste, and abuse investigations and audits required.
  • •The ability to understand and analyze health care claims and coding required.
  • •Experience conducting investigations of potential waste, abuse, and fraud.
  • •Ability to develop queries and reports to detect potential waste, abuse, and fraud.
Experience:2+ yearsHealthcareFraudClaims analysis
Skills:CommunicationProblem-solvingAnalytical thinkingAttention to detailCollaboration
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