Clinical Fraud Investigator

At Elevance Health, we are dedicated to providing top-quality healthcare services to our clients. As we continue to grow and expand our reach, we are seeking a highly skilled and experienced Clinical Fraud Investigator to join our team. As a Clinical Fraud Investigator, you will play a crucial role in identifying and preventing fraudulent activities within our healthcare system. Our ideal candidate is a detail-oriented and analytical individual with a strong background in healthcare and a passion for upholding ethical standards. If you are a driven and dedicated professional looking to make a difference in the healthcare industry, we encourage you to apply for this exciting opportunity.

1. Conduct thorough investigations into potential fraudulent activities within the healthcare system.
2. Utilize advanced analytical skills to identify patterns and trends in healthcare data.
3. Review medical records and other relevant documentation to determine the validity of claims.
4. Collaborate with other team members and departments to gather information and evidence for investigations.
5. Stay updated on current healthcare laws and regulations related to fraud and abuse.
6. Develop and implement strategies to prevent and detect fraudulent activities.
7. Prepare and present detailed reports and findings to management and legal teams.
8. Work closely with law enforcement and regulatory agencies as needed.
9. Maintain confidentiality of sensitive information and adhere to ethical standards.
10. Conduct interviews and gather statements from individuals involved in investigations.
11. Provide expert testimony in legal proceedings, if necessary.
12. Identify and recommend process improvements to prevent future occurrences of fraud.
13. Train and educate staff on fraud detection and prevention methods.
14. Stay informed on industry best practices and new techniques for fraud detection.
15. Perform other duties as assigned by management.

According to JobzMall, the average salary range for a Clinical Fraud Investigator in Norfolk, VA, USA is between $49,000 and $80,000 per year. This range may vary depending on factors such as years of experience, education level, and specific job responsibilities. Additionally, benefits such as health insurance, retirement plans, and bonuses may also impact the overall salary for this position.

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.