Job Description

Investigator II Location: Hybrid (office presence 1–2 days per week, with flexibility for virtual work). Candidates must be within a reasonable commuting distance from the posting location unless an accommodation is legally required. Job Description: Investigator II is responsible for identifying, investigating, and developing cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. The role includes claim reviews, data mining, entity reviews, law‑enforcement referrals, and use of proprietary data and claim systems for facility, professional, and pharmacy claims. How you will make an impact 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. Effectively establish rapport and ongoing working relationship with law enforcement. Interface internally with senior‑level management and legal department throughout investigative process. Assist in training of internal and external entities. Assist in the development of policy and/or procedures to prevent loss of company assets. Minimum Requirements Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience that provides an equivalent background. Preferred Skills, Capabilities, and Experiences 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. Health insurance, law enforcement experience preferred. Job Level Non‑Management Exempt Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long‑term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources. Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr

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