Clinical Fraud Investigator

Are you passionate about uncovering fraudulent activities in the healthcare industry? Are you a highly analytical and detail-oriented individual with a strong background in investigations? Elevance Health is seeking a dedicated Clinical Fraud Investigator to join our team and help us protect our clients from potential financial losses due to fraudulent practices. As a key member of our team, you will play a crucial role in detecting, investigating, and preventing fraud within the healthcare system. If you have a keen eye for detail, excellent problem-solving skills, and a strong sense of integrity, we want to hear from you. Read on to learn more about the qualifications and responsibilities for this exciting opportunity.

1. Conduct thorough investigations into potential cases of healthcare fraud, including but not limited to reviewing medical records, claims data, and billing information.
2. Utilize advanced analytical tools and techniques to identify patterns and anomalies that may indicate fraudulent activity.
3. Collaborate with cross-functional teams, including legal and compliance, to gather evidence and build strong cases against fraudulent individuals or organizations.
4. Stay up-to-date with industry regulations and best practices for identifying and preventing healthcare fraud.
5. Monitor and track suspicious activities and trends in healthcare data to proactively identify potential fraud risks.
6. Communicate findings and recommendations to management and stakeholders, including providing regular updates on investigations and outcomes.
7. Develop and maintain relationships with external partners, such as law enforcement agencies and regulatory bodies, to aid in investigations and potential legal action.
8. Maintain accurate and organized documentation of investigations, including evidence and supporting documentation.
9. Participate in training and development opportunities to continuously improve investigative techniques and stay current on industry trends.
10. Uphold a high level of confidentiality and integrity in handling sensitive information related to investigations.
11. Collaborate with the team to develop and implement fraud prevention strategies and procedures.
12. Support the company's overall mission and values by promoting ethical behavior and a commitment to preventing healthcare fraud.

According to JobzMall, the average salary range for a Clinical Fraud Investigator in Wallingford, CT 06492, USA is between $62,000 and $82,000 per year. However, this can vary depending on factors such as experience, education, and the specific company or organization the individual is working for. Some Clinical Fraud Investigators may also receive additional benefits such as healthcare and retirement benefits.

Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.