Clinical Fraud Investigator

Are you passionate about uncovering fraudulent activities and protecting the integrity of healthcare systems? Elevance Health is seeking a highly motivated and detail-oriented individual to join our team as a Clinical Fraud Investigator. As a vital member of our organization, you will utilize your investigative skills and healthcare knowledge to identify and prevent fraud, waste, and abuse within our network. If you have a strong sense of ethics and a desire to make a positive impact in the healthcare industry, we encourage you to apply for this exciting opportunity.

1. Conduct thorough investigations of potential fraudulent activities within the healthcare system.
2. Use healthcare knowledge and industry regulations to identify red flags and suspicious behavior.
3. Analyze data and evidence to determine the validity of claims and uncover any fraudulent patterns.
4. Work closely with other team members to ensure all investigations are completed accurately and in a timely manner.
5. Stay up-to-date on industry trends and changes in regulations to ensure effective fraud prevention strategies.
6. Communicate findings and recommendations to management and other relevant parties.
7. Develop and implement strategies to mitigate and prevent fraud, waste, and abuse within the network.
8. Collaborate with external organizations, such as law enforcement and regulatory agencies, to investigate and prosecute fraudulent activities.
9. Keep accurate and detailed records of investigations, findings, and outcomes.
10. Maintain a strict adherence to ethical standards and confidentiality requirements.
11. Provide support and guidance to other team members on fraud-related matters.
12. Participate in training and development opportunities to enhance investigative skills and knowledge of healthcare fraud.
13. Assist in the development and implementation of anti-fraud policies and procedures.
14. Conduct audits and reviews to identify potential areas of vulnerability and recommend corrective actions.
15. Serve as a subject matter expert on healthcare fraud for the organization.

According to JobzMall, the average salary range for a Clinical Fraud Investigator in Richmond, VA, USA is between $53,000 and $88,000 per year. Factors such as education, experience, and specific job responsibilities can affect the exact salary for this role.

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.