Clinical Fraud Investigator II

At Elevance Health, we are committed to delivering high-quality healthcare services to our patients while maintaining integrity and ethical standards. To ensure the highest level of care, we are seeking a highly skilled and experienced Clinical Fraud Investigator II to join our team. As a Clinical Fraud Investigator II, you will play a crucial role in identifying and preventing fraudulent activities within our organization. Your expertise in conducting thorough investigations and attention to detail will be essential in protecting our company and our patients from potential fraud. We are looking for a dedicated and driven individual who is passionate about upholding ethical standards and making a positive impact in the healthcare industry. If you have a strong background in fraud investigation, along with excellent communication and analytical skills, we encourage you to apply for this exciting opportunity.

1. Conduct thorough investigations into potential fraudulent activities within the organization.
2. Utilize various methods and techniques to identify and prevent fraud, including data analysis and interviews.
3. Review and analyze financial and medical records to identify patterns of fraudulent behavior.
4. Collaborate with other departments, such as compliance and legal, to gather information and evidence for investigations.
5. Maintain a thorough understanding of healthcare laws and regulations to ensure compliance in all investigations.
6. Communicate findings and recommendations to management and other stakeholders.
7. Develop and implement policies and procedures to prevent and detect fraudulent activities.
8. Conduct training sessions for employees on fraud prevention and detection.
9. Monitor claims and billing data to identify potential fraudulent behavior.
10. Stay up-to-date on current fraud trends and continuously adapt investigation techniques.
11. Maintain confidentiality and handle sensitive information in a professional manner.
12. Provide support to law enforcement and legal authorities during investigations and legal proceedings.
13. Represent the organization in meetings and discussions related to fraud prevention and detection.
14. Act as a subject matter expert on fraud investigation and prevention for the organization.
15. Uphold ethical standards and promote a culture of integrity within the organization.

According to JobzMall, the average salary range for a Clinical Fraud Investigator II in Atlanta, GA, USA is $74,000 - $110,000 per year. This can vary depending on factors such as years of experience, education level, and specific industry.

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.