14 Jobs in des moines, ia
Elevance Health is Hiring an Investigator II Near Des Moines, IA
The INVESTIGATOR II is 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.
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 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.
- Requires a BA/BS and minimum of 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.
- Health insurance, law enforcement experience preferred.
Job Summary
Full Time
$57k-83k (estimate)
06/21/2024
07/18/2024
The job skills required for Investigator II include Law Enforcement, Data Mining, etc. Having related job skills and expertise will give you an advantage when applying to be an Investigator II. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Investigator II. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Investigator II positions, which can be used as a reference in future career path planning. As an Investigator II, it can be promoted into senior positions as a Campus Police Officer that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Investigator II. You can explore the career advancement for an Investigator II below and select your interested title to get hiring information.
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