Clinical Fraud Investigator Senior

Are you passionate about protecting patients and upholding ethical standards in the healthcare industry? Do you have a keen eye for detail and a strong investigative mindset? If so, we have an exciting opportunity for you as a Senior Clinical Fraud Investigator at Elevance Health. In this role, you will play a critical role in detecting, investigating, and preventing fraudulent activities within our organization. We are seeking a highly experienced and motivated individual with a background in healthcare fraud investigation, strong analytical skills, and the ability to work independently. Join our team and make a difference in the fight against healthcare fraud.

1. Conduct thorough investigations into potential cases of healthcare fraud within the organization, utilizing various resources and tools for gathering evidence.
2. Apply knowledge of healthcare industry regulations and ethical standards to identify potential fraudulent activities and develop strategies for prevention.
3. Collaborate with internal teams, including compliance and legal, to ensure that all investigations are conducted in accordance with company policies and procedures.
4. Utilize advanced analytical skills to identify patterns and trends in data that may indicate fraudulent activities.
5. Interview witnesses and gather information from relevant parties to build a comprehensive case.
6. Prepare detailed reports and presentations on findings and recommendations for senior management and regulatory agencies.
7. Develop and maintain relationships with external partners, such as law enforcement and regulatory agencies, to aid in investigations and stay updated on industry developments.
8. Stay up to date on industry regulations and best practices related to healthcare fraud detection and prevention.
9. Train and educate colleagues on fraud detection and prevention methods to ensure a company-wide understanding of ethical standards and compliance.
10. Maintain strict confidentiality and discretion in handling sensitive information related to investigations.

According to JobzMall, the average salary range for a Clinical Fraud Investigator Senior in St. Louis, MO, USA is $70,000-$90,000 per year. This may vary depending on the specific job duties, experience level, and employer.

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.