Clinical Fraud Investigator II

Welcome to Elevance Health, where we are committed to providing exceptional healthcare services to our patients. We are currently seeking a highly skilled and experienced Clinical Fraud Investigator II to join our team. As a Clinical Fraud Investigator, you will play a crucial role in protecting our organization from fraudulent activities and ensuring that our patients receive the highest quality of care. We are looking for a detail-oriented and analytical individual who is passionate about fighting fraud in the healthcare industry. If you have a strong background in healthcare fraud investigations and are dedicated to upholding ethical standards, we encourage you to apply for this exciting opportunity.

1. Conduct thorough investigations into potential cases of healthcare fraud, waste, and abuse.
2. Identify and analyze patterns and trends in healthcare claims data to detect potential fraudulent activities.
3. Utilize various investigative techniques and tools to gather evidence and build cases against suspected fraudsters.
4. Work closely with other members of the healthcare team, including physicians and administrators, to identify potential areas of vulnerability and implement preventative measures.
5. Review medical records, claims, and other relevant documents to detect discrepancies and anomalies.
6. Collaborate with law enforcement agencies and other external partners to investigate and prosecute fraudulent activities.
7. Conduct interviews and gather statements from witnesses and subjects of investigations.
8. Prepare detailed reports and presentations to communicate findings and recommendations to management and other stakeholders.
9. Keep up-to-date with industry regulations and best practices related to healthcare fraud investigations.
10. Maintain the confidentiality and security of sensitive information and evidence obtained during investigations.
11. Provide training and guidance to other team members on fraud detection and prevention.
12. Represent the organization in legal proceedings related to healthcare fraud investigations.
13. Uphold ethical standards and promote a culture of integrity and compliance within the organization.
14. Participate in special projects and initiatives related to fraud prevention and detection.
15. Continuously monitor and evaluate the effectiveness of fraud prevention measures and make recommendations for improvement.

According to JobzMall, the average salary range for a Clinical Fraud Investigator II in Tampa, FL, USA is $60,000 to $70,000 per year. This may vary depending on the specific company, location, and years of experience. Some companies may offer higher salaries for more experienced investigators.

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.