Experience : 0 Description : Your Talent. Our Vision. At Anthem, Inc.,
it's a powerful combination, and the foundation upon which we're
creating greater access to 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 at one of America's leading health benefits companies and a
Fortune Top 50 Company.TheInvestigator I or IIis responsible for the
identification, investigation and development of 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 identifying and developing enterprise-wide specific
healthcare investigations that may impact more than one company health
plan, line of business and/or state. * Must be able to effectively
establish rapport and on-going working relationship with law
enforcement. * 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. * Health
insurance, law enforcement experience preferred. Investigator I *
Requires BA/BS, 2 years related experience preferably in health
insurance, law enforcement; or any combination of education and
experience, which would provide an equivalent background.Investigator II
- Requires BA/BS degree, 3 years related experience; 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
2017 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 FraudEqual Employment Opportunity
StatementAnthem, 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 or II - Remote -
PS4809 Location: new york-Hempstead Requisition ID: PS4809
County : Nassau URL :
https://nlx.jobsyn.org/d76a667e40404a31a09b0b826e0b46e6159