SIU Investigator

Centene
Florida
Workplace: RemoteFull timeUSD 56,200 - 101,000 annuallyFunction: Software EngineeringExperience: 1+ yearsEducation: bachelorsSkills: []

Investigate and document potential healthcare fraud and abuse, planning and executing claims investigations or audits. Perform data mining on claims, develop queries, and coordinate with Health Plans to recommend actions, with a focus on waste, abuse, and fraud detection for Centene’s 28 million members.

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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: 15 days agoStatus: Live
Reposted: similar role first listed 5 months ago

Job Summary

Investigate and document potential healthcare fraud and abuse, planning and executing claims investigations or audits. Perform data mining on claims, develop queries, and coordinate with Health Plans to recommend actions, with a focus on waste, abuse, and fraud detection for Centene’s 28 million members.
Location: Florida
Workplace: Remote
Employment Type: Full time
Job Function: Software Engineering

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 Insurance401kRemote 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.
  • •Ability to conduct investigations of potential waste, abuse, and fraud and document activity on each case.
  • •Perform data mining and analysis to detect aberrancies and outliers in claims; develop new queries and reports.
  • •Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies.
Experience:1+ yearsHealthcareFraud investigationClaims analysis
Education:Bachelor's

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