Centene Management Company LLC is seeking an SIU Investigator to investigate allegations of potential healthcare fraud and abuse activity. You will assist in planning, organizing, and executing claims investigations or audits that identify, evaluate, and measure potential healthcare waste, abuse, and fraud.
What You'll Do
- Conduct investigations of potential waste, abuse, and fraud.
- Document activity on each case and refer issues to the appropriate party.
- Perform data mining and analysis to detect aberrancies and outliers in claims.
- Develop new queries and reports to detect potential waste, abuse, and fraud.
- Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions.
- Assist with complex allegations of healthcare fraud.
- Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies.
- Complete various special projects and audits.
What We're Looking For
- Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field, or equivalent experience.
- 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience.
Benefits & Compensation
- Annual salary range: $55,100.00 - $99,000.00.
- Health insurance.
- 401K and stock purchase plans.
- Tuition reimbursement.
- Paid time off plus holidays.
- Flexible approach to work with remote, hybrid, field, or office work schedules.
Work Mode
This position follows a hybrid work model.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
