Centene Management Company LLC is seeking an SIU Investigator to join its pharmacy investigations team. In this role, you will investigate allegations of potential healthcare fraud and abuse, playing a key part in our mission of transforming the health of our communities.
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
- Assist with complex allegations of healthcare fraud
- Prepare summary and 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, or related field, or equivalent experience
- 1+ years of Medical/pharmacy claim investigation, audit, analysis, or fraud investigation
Benefits & Compensation
- Compensation: $56,200.00 - $101,000.00 per year
- Competitive pay
- 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 role follows a hybrid work model.
